Senior Medical Stop-Loss Claims Auditor
This position is located on-site in San Francisco, CA.
Audits and authorizes reimbursement of specific medical stop-loss claims.
Effectively mitigates client medical stop-loss claims and provides excellent customer service.
Associate degree, OR
Two years of medical claims experience.
Required Work Experience
Six years of medical claims and/or reinsurance claims experience.
Previous lead and/or supervisory experience.
Required Skills and Abilities
Excellent customer-service, organizational and critical-thinking skills.
Strong analytical skills.
Knowledge of group insurance, managed care and direct medical claims products.
Advanced knowledge of aggregate claims auditing.
Knowledge in COB, Medicare, HIPAA, CPT, ICD-9 and benefit plan interpretation.
Ability to work independently with minimal supervision while meeting or exceeding established production and accuracy standards.
Ability to persuade, negotiate with or influence others.
Microsoft Office skills.
We are an Equal Opportunity/Affirmative Action Employer. We will consider all qualified applicants for employment regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status.