Claims Auditor

WM MICHAEL STEMLER INC

Stockton, CARemote OKFull time

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Pay: $22 to $26; an hour
Location: Stockton, CA
Work style: Remote OK
Job type: Full time
Posted: Oct 21; 5 days ago

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About the company

WM MICHAEL STEMLER INC

Insurance and Employee Benefit Funds · 51 to 200 employees

As an independent leader in third-party benefits administration, we’ve been successfully delivering comprehensive self-funded health plans since 1968. With an extensive menu of integrated care management and wellness programs, we build custom plans that proactively manage plan utilization, improve health outcomes, and ultimately reduce costs.

Our mission is simple: to provide access to healthcare for more people by making self-funded plans easy and affordable.

At Delta, you can trust us to deliver as promised.

Connect with us today.

Patrick McTighe Chief Experience Officer Patrick.McTighe@DeltaTPA.com

WM MICHAEL STEMLER INC on LinkedIn

What you'll do

The Claims Auditor is responsible for auditing self-funded claims and customer service work to ensure accuracy against established guidelines.
They also identify technical and system quality issues while documenting statistics and providing feedback to management.

What you need

Candidates must have one to three years of related experience or a one-year technical certificate.
Proficiency in medical, dental, and hospital claims processing, along with strong analytical and Microsoft Office skills, is required.
Education: a professional certificate

Key skills

Claims auditingQuality controlClaims processingMedical claimsDental claimsHospital claimsCustomer serviceData documentationAnalytical skillsMicrosoft WordMicrosoft ExcelPolicy interpretationSystem editsOrganizational skills

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Read the full posting here

Job Details: Job Location: DHS Remote - Stockton, CA 95219, Position Type: Full Time, Salary Range: $22.00 - $26.00 Hourly, Job Category: QA - Quality Control, Audits Claims, Customer Service and OA personnel by performing the following duties. Audits work of self-funded Claims and Customer Service department for accuracy according to established procedure guidelines. Reviews and identifies technical and system quality issues for all aspects of claim processing, corr/recon, and customer service. Documents, maintains and reports audit statistics Accurately interprets claim policy, procedures and standard group benefit provisions Provides feedback to management and reviewed employees regarding quality of work Maintains confidentiality of employee audits Adheres to company rules and regulations. Maintains a professional relationship and interacts with peers, subordinates, superiors in an efficient and productive manner Performs other duties as assigned Qualifications: EDUCATION/EXPERIENCE: One year certificate from college or technical school; or one to three years related experience; and/or equivalent combination of education/experience. QUALIFICATIONS: Successful candidate will have medical, dental and hospital claims processing experience; a strong understanding of computerized claims payment systems, preferably at Delta Health Systems; excellent organizational skills; a thorough understanding of technical claims issues and system edits; working knowledge of Microsoft Word and Excel; and exceptional analytical skills.