- Perform technical audit on medical claims
- Justify the rejection reasons on system in rejection cases to facilitate the reconciliation process.
- Proper implementation of agreements on claims in collaboration with the audit and processing team
- Audit of invoice
- Coordination with other adjusters for distribution of the claims
- Escalation of any problematic area to direct manager.
- Formulate and handle exceptions of claims.
- Individually monitors, analyzes and reports claims information including relevant health care trends and high cost claims by segment.
- Review claims, hospital bills, and physician notes and data to devise and refine procedures for identifying and resolving billing errors and provider billing practices.
- Work with the health plan provider team and the auditing team to develop ongoing processes for auditing provider bills, recording errors and tracking collections.
Bachelor's DegreePrevious experience as a claims auditor or Receptionist in Medical Labs