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Description:

Position located in Westmont, Illinois - remote eligible. Benefit eligible (medical/dental) from the first day of employment.

Perform Quality Auditing of Claim Adjudicators and Customer Service Representatives. Audit capitation deductions, preparing summary of findings and disputes to the various HMOs. Review and respond to Stat Fax/Past Due Claim (PDC) inquiries from the HMOs.

• Review claims for accuracy of information into the claims processing system and ensure Standard Operating procedures (SOPs) have been followed. Provide feedback to staff as errors are identified, including where procedures can be found on correct handling when appropriate.
• Work closely with Operations Manager to identify areas requiring additional training, either on an individual basis or overall.
• Review authorization/...