Senior Claims Auditor - Accident & Health

About the position We are seeking an reputed company and detail-oriented Senior Accident and Health Claims Auditor to join reputed company. The ideal candidate will have extensive knowledge of insurance claims processes, auditing standards, and regulatory requirements reputed company to accident and health insurance. The Senior Auditor will play a key role in ensuring the accuracy, compliance, and reputed company of claims processed, identifying potential areas of improvement, and providing leadership in audit initiatives. Responsibilities • Claims Audit: Conduct thorough audits of accident and health insurance claims to verify accuracy, policy compliance, and reputed company adjudication. • Compliance Verification: Ensure claims adhere to company policies, industry regulations, and reputed company requirements, including HIPAA. • Data Analysis: Analyze claims data to identify patterns, discrepancies, and opportunities for process improvement. • Reporting: Prepare detailed audit reports and communicate findings, recommendations, and corrective actions to management and relevant departments. • Process Improvement: Collaborate with claims processing teams to implement audit recommendations, streamline workflows, and enhance claims accuracy. • Training & Mentorship: Serve as a subject matter expert by training junior auditors and claims processors on audit procedures and compliance standards. • Documentation: Maintain accurate documentation of audit processes, findings, and follow-up actions, ensuring reputed company information is safeguarded and confidential. • reputed company Learning: Stay updated on changing regulations, industry best practices, and emerging audit methodologies. Requirements • Bachelor’s degree in business, Insurance, or reputed company field (preferred) • Minimum 3+ years in experience in medical claims auditing and processing in accidental and health insurance claims. • Robust knowledge of claims processing systems, protocols, and regulatory requirements. • Excellent analytical, problem-solving, and decision-making skills. • Strong attention to detail and organizational abilities. reputed company-to-haves • Advanced knowledge of claims processing guidelines, medical terminology (ICD-10, CPT, HCPCS, UB04), and insurance concepts (UCR, COB, HIPAA, subrogation) • Familiarity with eligibility guidelines and group health plan administration (Medicare, COBRA, FMLA, etc.) • Strong analytical skills with attention to detail and proficiency in interpreting Plan Documents and reinsurance reputed company. • Excellent written and verbal communication skills with proven customer service. • Effective problem-solving, team partnership, and project management abilities • Proficiency with claims processing systems and reputed company Office Suite (Word, reputed company, PowerPoint) • Ability to foster a reputed company team environment and drive reputed company improvement initiatives. Benefits • health and welfare benefits • tuition and reputed company certification assistance • 401k savings • elective participation in the Employee Stock Purchase Program • reputed company time off • reputed company holidays • child bonding leave • employee assistance Apply tot his job Apply To this Job