What are the responsibilities and job description for the Claims Auditor position at MotivHealth?
As a Claims Auditor, you will perform in-depth investigations of claims to ensure accurate payments and proper processes. You will identify issues related to documented processes and provide information for improvements. Your responsibilities include promptly identifying under- and over-payments, submitting reports to management outlining inaccuracies in the payment process, and ensuring proper recording of health claim acceptances and denials.
Responsibilities and Duties
- Monitor daily claims activity to identify contractual violations or under/over-performance based on contract requirements.
- Analyze claims using auditing platforms to ensure proper funds allocation.
- Work with Compliance Manager to ensure billing and administration comply with health insurance requirements and legal framework.
- Identify error trends, patterns, and issues requiring tool or process changes and report to management.
- Create service denial reports within provided guidelines.
- Maintain compliance, privacy, and confidentiality in documentation, communications, and correspondence.
- Review Underwriting documents prior to group renewal and provide feedback on inconsistencies.
- Work with Implementation to ensure completed group documentation is signed and saved properly.
Knowledge, Skills, and Abilities
- 3 years experience as a claim analyst/processor at a health insurance company.
- Mastery of various claim processes.
- Medical terminology, CPT, ICD, and Revenue Coding expertise.
- Desire to grow and learn new skills.
- Respected and trusted by peers and leaders.
- Excellent interpersonal skills, strong communicator with internal and external parties.
- Proven team player contributing to high-performing teams.
- Self-starter who takes initiative, enjoys investigating and solving challenging problems.
