Job Description:
Medical Claims Auditor / Trainer
(Health Insurance)
(CPT, ICD-10)
Newtown Square, PA
(Full Time, Permanent Role)
We are an established employer in Newtown Square, Delaware
County, Pennsylvania, and are seeking a full-time Claims Auditor -
Trainer to join our team.
This Non-Exempt position consists of a 37.50-hour work
week with daily work hours of: 8:30am to 5:00pm,
Monday through Friday.
About the role:
This position is responsible for auditing the Health Plan claims for
accuracy including manually-processed claims as well as any claims
that were adjudicated electronically via BlueCross, Guardian, Medicare
Crossover and SDS.
The position is also responsible for any "in-house
training" for all new claims employees or of existing claims
personnel on any changes.
Key Responsibilities Include:
· Responsible for auditing claims for accuracy and maintaining a
99.55% accuracy rating on all audited claims,
· Responsible for identifying errors and making the proper
adjustments as needed,
· Responsible for finalizing claims in BlueCross CADF and GUI systems,
· Responsible for all in-house training of all new claims examiners
or member service representatives on the company health plan benefits,
procedures, and the claim payment systems,
· Responsible for training all existing claims personnel on plan
benefit and system changes,
· Responsible for completion and accurate release of claims that
require adjustments,
E.O.E./M/F/H/V