Claims Audit Analyst

Summary

Join WelbeHealth's Health Plan Services team as a Claims Audit Analyst and ensure timely and accurate claim processing. You will review processed claims for accuracy, maintain detailed documentation of audit findings, and move error-free claims through adjudication. Provide feedback to management on processing errors and quality improvement opportunities. This role requires at least three years of experience auditing Medicare and Medicaid claims and demonstrated skills in Microsoft Office applications. WelbeHealth offers a competitive compensation package, including medical, dental, and vision insurance, 17 days of PTO, 12 paid holidays, and advancement opportunities.

Requirements

• Must have a minimum of three (3) years of experience with claims processing and auditing Medicare and Medicaid professional, institutional, and dental health insurance claims
• Must have experience working with CMS and Medicaid healthcare claims
• Demonstrated skills within Microsoft Office Applications, including Excel

Responsibilities

• Review processed claims for accuracy prior to payment while maintaining acceptable levels of claim’s aged inventory by verifying various aspects of the system and claim
• Complete and maintain detailed documentation of audit findings which include decision methodology, system or processing errors, and monetary discrepancies
• Move claims free of processing errors through for full adjudication and return claims with errors back to the claims team for corrections
• Provide feedback to the Oversight & Monitoring Manager on claims processing errors, quality improvement opportunities, and configuration change requests, when applicable

Benefits

• Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
• Work/life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time
• Advancement opportunities - We’ve got a track record of hiring and promoting from within, meaning you can create your own path!
• 401k match
• Healthcare coverage