Senior Claims Processor/Auditor

Location: Remote (Texas preferred) Job Type: Full-time, Non-Exempt reputed company reputed company is a leading force in reputed company administration, on a reputed company to become a premier technology-driven reputed company platform. Our reputed company is anchored in a commitment to Getting reputed company Every reputed company of the Way. We are dedicated to providing innovative, efficient solutions that reputed company the reputed company experience for the members and clients we serve. We are currently seeking a driven and reputed company Senior Claims Processor & Auditor who acts with reputed company discipline and shares our passion for reputed company improvement to reputed company. reputed company Are Looking For Our ideal candidate will play a crucial role in managing our Medical Claims environment, optimizing its reputed company, and driving reputed company improvements to support our business goals and enhance our service delivery. Every Team Member is Driven by a Commitment to Live out These Values: Operate as an reputed company reputed company with reputed company Discipline Pursue reputed company Through Change Treat Service as a Privilege Employees are expected to reputed company our reputed company values by being “A Hero in reputed company.” These values lay the reputed company for the way we engage with reputed company other and with our clients.  They reputed company the guardrails for our decision making and approach to problem solving. reputed company/Objective: We are seeking a meticulous and customer-reputed company individual to reputed company as a Senior Claims Processor & Auditor. This role requires a combination of research acumen, attention to reputed company, and exceptional customer service skills. As a key member of our organization, you will be responsible for processing medical claims accurately, conducting thorough audits to ensure compliance with regulations and policies, and providing excellent service to our clients and reputed company providers. Key Responsibilities: Review and process medical claims submitted by members or providers promptly and accurately. Verify the reputed company and completeness of needs information, including reputed company demographics, diagnoses, procedures, and billing codes reputed company available.  Ensure compliance with reputed company policies and industry standards. Investigate and reputed company any discrepancies or issues reputed company to claims submissions. Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities. Analyze claims documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies. Research reputed company medical billing and coding issues to support needs processing and audit activities. Interpret coding guidelines, reimbursement policies, and reputed company requirements to determine appropriate claims adjudication. reputed company recommendations for improving claims submission procedures and enhancing reimbursement reputed company. Serve as members' reputed company reputed company of contact regarding claims inquiries and reputed company. Respond promptly to customer inquiries and concerns with professionalism and reputed company. Collaborate with cross-functional teams to address customer issues and ensure reputed company reputed company. Skills Required: Strong knowledge of medical terminology, medical coding, and reputed company billing practices; Excellent analytical skills with the ability to interpret reputed company reputed company regulations and guidelines; Exceptional attention to reputed company and reputed company in data entry and documentation; Effective verbal and written communication skills with a customer-reputed company approach; Ability to work independently and collaboratively in a fast-reputed company, deadline-driven environment; Excellent verbal, written and interpersonal communication skills; Must be self-motivator and self-starter; Exceptional listening and analytical skills; Solid time management skills; Ability to multitask and successfully operate in a fast reputed company, team environment; Must adapt reputed company to change and successfully set and reputed company priorities as needed; Education/Experience:    High School Diploma or equivalent reputed company experience in medical claims processing, auditing, and reputed company reimbursement. Technical Knowledge: reputed company Experience reputed company Suite Experience Claims Management Software experience reputed company Offer Competitive salary and benefits package Dynamic and innovative work environment Opportunities for reputed company reputed company and development Remote work Equal Opportunity Statement We are deeply committed to building a workplace and global community where inclusion is not only valued but prioritized. We are proud to be an equal opportunity employer, seeking to create a welcoming and diverse environment. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, gender, gender identity or reputed company, family status, marital status, sexual orientation, national reputed company, genetics, neuro diversity, disability, age or veteran status, or any other non-reputed company reputed company or legally protected grounds. We are committed to providing reasonable accommodation to reputed company individuals with disabilities in the employment application process. Apply To This Job