Insurance Claims Validator

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Insurance Claims Validator: REMOTE POSITION CURRENTLY

You will gain valuable insurance claims experience through auditing medical claims to discover discrepancies related to insurance overpayments. You will research and investigate insurance claims in various systems, as well as audit claims for accuracy and eligibility. Once the claim is determined to be legitimate, records are updated accordingly. If fund recovery opportunities are identified, the claim record(s) are then sent to the fund’s recovery team for additional follow-up on behalf of the largest healthcare providers in the world.

Responsibilities: Identify and define claims errors and discrepancies. Review and analyze provider contracts and health plan reimbursement regulations. Update and develop new and current audit reports and develop and run custom queries. Working with a variety of claims including Medicare, Facility, In-Patient, and Out-Patient. Develop and implement new ideas that will help better recognize incorrect payments and generate a higher quality of recoverable claims. Meet or exceed department attendance and quality goals.

What we offer:

Full-time, 40 hours per week, Monday – Friday, 8-5 pm schedule. (Flexible schedule after completing a 4-week paid training program)

Full health, dental, and vision insurance, STD/LTD, vacation, sick time, 401K with a company match, tuition reimbursement, and more!

Career advancement opportunities. Competitive salary based on experience.

Casual dress code.

Applicant for this job will be expected to meet the following minimum qualifications:

Education: Must be 18 years or older. HS diploma or GED required.

Experience: 1 year experience in medical insurance claim processing, auditing, medical coding or related experience preferred or prior experience with EOBs, Provider/Member contracts, COBs, ICD 9/10, CMS Coding, etc.

Experience using general office software such as: Outlook, Word, Excel