Claims Auditor II (Medicare Claims Exp. required) # 123291
Location:
Posted:
November 18, 2016
Reference:
119361267
/Your Talent. Our Vision./ At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it's a powerful combination. It's the foundation upon which we're creating greater care for our members, greater value for our customers and greater health for our communities. Join us and together we willdrive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Responsible for pre and post payment and adjudication audits of high dollar claims across multiple lines of business, claim types and products including specialized claims within Service Experience. Works independently and without significant guidance.

Primary duties may include, but are not limited to:
Performs audits of and may adjudicate high dollar claims while maintaining acceptable levels of claims inventory and age.
Ensures claim payment accuracy by verifying various aspects of the claim including eligibility, system coding and pricing, pre-authorization, and medical necessity.
Contacts others to obtain any necessary information.
Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis.
Provides feedback on claims processing errors; identifies quality improvement opportunities and initiates basic and complex system requests related to coding or system issues.
Refers overpayment opportunities to Recovery Team.
Independently interprets Medical Policy and Clinical Guidelines. Must possess strong research and problem solving skills. Requires a High School diploma or GED; 5 years of claims processing experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector) with consistent above target performance; working knowledge of insurance industry and medical terminology; detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; and ability to acquire and perform progressively more complex skills and tasks in a production environment or any combination of education and experience which would provide an equivalent background.
EOE.M/F/Disability/Veteran

Must possess strong research and problem solving skills.
Requires a High School diploma or GED;
5 years of claims processing experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector) with consistent above target performance; working knowledge of insurance industry and medical terminology; detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; and ability to acquire and perform progressively more complex skills and tasks in a production environment or any combination of education and experience which would provide an equivalent background.
/Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at//antheminc.com/careers//. EOE. M/F/Disability/Veteran./

Job Claims

Title: Claims Auditor II (Medicare Claims Exp. required) # 123291

Location: CA-Cerritos

Requisition ID: 123291
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