[Remote] Process Auditor I
Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey is a health solutions leader dedicated to improving healthcare quality and member experience. They are seeking a Process Auditor I to ensure excellent customer service by resolving inquiries from hospitals and managing claims adjustments effectively.
Responsibilities
ā¢ Provide resolution to identified overpayments utilizing various methods i.e., written correspondence, outbound call, or adjustment to a claim
ā¢ Research/adjust claims (i.e., Coordination of Benefits, no-fault, claim policy, authorizations, and referrals) in accordance with Plan contract provisions and all other governing policies and/or procedures
ā¢ Research and resolve Accounts Receivable (AR) issues to include the disposition of Cash Receipts in Universal Payment System (UPS)
ā¢ Ensure accurate and timely resolution of service requests and activities is provided in accordance with the customer's health benefit coverage and company policy
ā¢ Anticipate and resolve potential issues and follow through on commitments made to the customers
ā¢ Coordinate with other areas within and outside of Service to address customers' inquiries regarding claim payment, benefits and/or appeals
ā¢ Follow up on unresolved issues via outbound calls, emails or faxes
ā¢ Share knowledge and information willingly with team members to achieve team, division, and Enterprise goals while enhancing service quality
ā¢ Submit provider file updates as appropriate
ā¢ Receive inbound telephone calls as they relate to recovery efforts
ā¢ Perform other related tasks as assigned by management
Skills
ā¢ High School Diploma/GED required
ā¢ 1 to 2 years customer service/benefit processing experience
ā¢ Strong PC skills
ā¢ Analytical thinking
ā¢ Strong written and verbal communication necessary
ā¢ Strong knowledge of Medical terminology preferred
Benefits
ā¢ Comprehensive health benefits (Medical/Dental/Vision)
ā¢ Retirement Plans
ā¢ Generous PTO
ā¢ Incentive Plans
ā¢ Wellness Programs
ā¢ Paid Volunteer Time Off
ā¢ Tuition Reimbursement
Company Overview
ā¢ Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com.
Apply Now
Apply Now
Responsibilities
ā¢ Provide resolution to identified overpayments utilizing various methods i.e., written correspondence, outbound call, or adjustment to a claim
ā¢ Research/adjust claims (i.e., Coordination of Benefits, no-fault, claim policy, authorizations, and referrals) in accordance with Plan contract provisions and all other governing policies and/or procedures
ā¢ Research and resolve Accounts Receivable (AR) issues to include the disposition of Cash Receipts in Universal Payment System (UPS)
ā¢ Ensure accurate and timely resolution of service requests and activities is provided in accordance with the customer's health benefit coverage and company policy
ā¢ Anticipate and resolve potential issues and follow through on commitments made to the customers
ā¢ Coordinate with other areas within and outside of Service to address customers' inquiries regarding claim payment, benefits and/or appeals
ā¢ Follow up on unresolved issues via outbound calls, emails or faxes
ā¢ Share knowledge and information willingly with team members to achieve team, division, and Enterprise goals while enhancing service quality
ā¢ Submit provider file updates as appropriate
ā¢ Receive inbound telephone calls as they relate to recovery efforts
ā¢ Perform other related tasks as assigned by management
Skills
ā¢ High School Diploma/GED required
ā¢ 1 to 2 years customer service/benefit processing experience
ā¢ Strong PC skills
ā¢ Analytical thinking
ā¢ Strong written and verbal communication necessary
ā¢ Strong knowledge of Medical terminology preferred
Benefits
ā¢ Comprehensive health benefits (Medical/Dental/Vision)
ā¢ Retirement Plans
ā¢ Generous PTO
ā¢ Incentive Plans
ā¢ Wellness Programs
ā¢ Paid Volunteer Time Off
ā¢ Tuition Reimbursement
Company Overview
ā¢ Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com.
Apply Now
Apply Now