What are the responsibilities and job description for the Claims Auditor position at Conner Strong & Buckelew Companies, LLC?

Job Description

Department : Employee Benefits

Job Type : Contract

Job Summary : Reporting to the Manager of Claims Audit Services, the Claims Auditor will serve on a team responsible for performing audits of third-party administrators on behalf of an Employee Benefits or AIM client. Must understand client business goals and how their benefit programs advance / interface with those goals. Uses team resources appropriately to deliver superior audit-consulting services to clients and assist in audit projects.

Principal Responsibilities

The Claims Auditor actively participates in medical claim audits for AIM and Conner Strong & Buckelew clients. The Claims Auditor has the responsibility to :

Gather and review all documentation necessary to conduct claims audit, including benefit plan descriptors
Interact with claims administrators in a professional, effective and efficient way, usually under stressful situations involving (somewhat) antagonistic interests
Maintain positive contact with clients regarding work products and client inquiries
Assist in preparation of audit reports and written communications for clients; assist in delivery of claims audit results to client senior management
Report to client account managers regarding status of audit projects and client requests
Assist in ensuring that claims audits are conducted in a timely, efficient manner
Educate colleagues on AIM claims audit capabilities

Requirements

Minimum 5 years of claims auditing experience

Strong technical knowledge and understanding of the variety of benefit plan designs, including PPO, POS, HMO, HDHP, HSA, Indemnity

Proficiency with healthcare claim adjudication standards and procedures, including application of benefit plan designs, COB, TPL / subrogation issues.

Proficiency with all healthcare coding methods (e.g., CPT, HCPCS, DRG, ICD, hospital revenue codes).

Demonstrated knowledge of stop loss preferred but not required

Ability to work independently and as part of a productive audit team.

Excellent organizational, communication, decision-making, interpersonal, collaborative and consultative skills; proven ability to multi-task under pressure

Proficiency in MS Office (Word, Excel, PowerPoint, Access)

Excellent oral and written communication skills.

Working Conditions

Office environment with moderate noise level; able to work flexible hours if needed.

Conner Strong & Buckelew is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, gender, affectional or sexual orientation, gender identity or expression, national origin, ancestry, nationality, age, disability (physical or mental), marital or domestic partnership or Civil Union status, pregnancy, family medical history or genetic information, atypical cellular or blood trait, military service or any other status protected by law.

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