Job Description:
• Review and verify insurance claims for accuracy, completeness, and compliance with policy terms and regulatory requirements
• Audit claim files and analyze claim payment accuracy, including complex claims
• Review and interpret Explanation of Benefits (EOB), Explanation of Payment (EOP), and Remittance Advice documents
• Identify inconsistencies, discrepancies, or potential errors and escalate findings to the appropriate teams for resolution
• Ensure claim payments align with company procedures, contractual guidelines, and regulatory standards
• Collaborate with management and claims processing teams to research and resolve claim issues
• Maintain current knowledge of state and federal regulations related to insurance claims and compliance requirements
• Prepare audit documentation, reports, and summaries outlining findings and recommendations
Requirements:
• Experience reviewing and verifying healthcare insurance claims for accuracy and compliance
• Experience reviewing and interpreting EOB/EOP and Remittance Advice
• Prior experience conducting claim audits or payment accuracy analysis
• Knowledge of state and federal insurance regulations and compliance standards
• Strong attention to detail with the ability to analyze complex information
• Effective written and verbal communication skills
• Ability to work independently in a remote environment while managing priorities and deadlines
Benefits:
• generous, flexible vacation policy
• 401(k) employer match
• comprehensive health benefits
• educational assistance
• leadership and technical development academies
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