Claims Quality and Audit Representative
About the positionResponsibilities• Validate / analyze claim data for accuracy utilizing job aids, claim documents, policies, and procedures• Deliver / communicate fact-based quality review determinations in objective, non-confrontational manner• Provide supporting documentation for audit findings• Maintain tracking/reporting of daily tasks• Achieve production and quality goals/metrics• Identify / communicate uncommon patterns / trends to Team Lead / Manager• Demonstrate working knowledge of product, process, systems and applicationsRequirements• High School Diploma / GED• Must be 18 years of age OR older• 3+ years of professional work experience / knowledge of the healthcare industry• 1+ year of telecommuter experience• Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications• Experience with bolthires Excel (data entry, sort / filter, and work within tables) and bolthires Outlook (email and calendar management)• Ability to work between the hours of 6:30 am - 3:30 pm MST from Monday - Friday including the flexibility to work occasional overtime based on business needNice-to-haves• 3+ year of medical claims and / OR auditing experience• Knowledge of insurance and / OR medical terminology• Product / process knowledge• System / application knowledgeBenefits• Comprehensive benefits package• Incentive and recognition programs• Equity stock purchase• 401k contribution Apply tot his job