Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Claims Audit Specialist
Job Description
The Claims Audit Specialist supports management in the design, implementation, and maintenance of claims auditing programs. Responsible for auditing claims for accuracy. Verify that claims are being adjudicated according to contracts in a consistent and accurate manner. Work closely with claims department to report issues and determine resolutions.Responsibilities
- Review benefit plans to ensure that claims are being adjudicated accurately and consistently according to contracts. Audits claims for financial accuracy.
- Responsible for documenting and reporting issues found.
- Assist with the establishment and updating of processes and audit manuals.
- Identify areas where issues exist and works with appropriate individuals to ensure resolution.
- Complete special focused audits as assigned by management.
- Act as a resource for the auditing team.
- Other duties as assigned
Minimum Qualifications
- High School Diploma or GED Required
- 1 year of claims experience
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
- Ability to read and understand benefit plans.
- Knowledge of coordination of benefit guidelines and an understanding of the adjustment and resolution process.
- Experience with multiple claim processing systems and ability to handle multiple accounts and priorities.
- Must function independently with strong organizational, interpersonal, verbal, and written communication skills.
- An understanding of the contracts, business and insurance principles related to claims adjudication.
Preferred Qualifications
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.
Potential pay for this position ranges from $21.15 - $31.73 based on experience and skills.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
