[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
• Provide resolution to identified overpayments utilizing various methods i.e., written correspondence, outbound call, or adjustment to a claim
• 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
• Research and resolve Accounts Receivable (AR) issues to include the disposition of Cash Receipts in Universal Payment System (UPS)
• Ensure accurate and timely resolution of service requests and activities is provided in accordance with the customer's health benefit coverage and company policy
• Anticipate and resolve potential issues and follow through on commitments made to the customers
• Coordinate with other areas within and outside of Service to address customers' inquiries regarding claim payment, benefits and/or appeals
• Follow up on unresolved issues via outbound calls, emails or faxes
• Share knowledge and information willingly with team members to achieve team, division, and Enterprise goals while enhancing service quality
• Submit provider file updates as appropriate
• Receive inbound telephone calls as they relate to recovery efforts
• Perform other related tasks as assigned by management
Skills
• High School Diploma/GED required
• 1 to 2 years customer service/benefit processing experience
• Strong PC skills
• Analytical thinking
• Strong written and verbal communication necessary
• Strong knowledge of Medical terminology preferred
Benefits
• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement
Company Overview
• 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
• Provide resolution to identified overpayments utilizing various methods i.e., written correspondence, outbound call, or adjustment to a claim
• 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
• Research and resolve Accounts Receivable (AR) issues to include the disposition of Cash Receipts in Universal Payment System (UPS)
• Ensure accurate and timely resolution of service requests and activities is provided in accordance with the customer's health benefit coverage and company policy
• Anticipate and resolve potential issues and follow through on commitments made to the customers
• Coordinate with other areas within and outside of Service to address customers' inquiries regarding claim payment, benefits and/or appeals
• Follow up on unresolved issues via outbound calls, emails or faxes
• Share knowledge and information willingly with team members to achieve team, division, and Enterprise goals while enhancing service quality
• Submit provider file updates as appropriate
• Receive inbound telephone calls as they relate to recovery efforts
• Perform other related tasks as assigned by management
Skills
• High School Diploma/GED required
• 1 to 2 years customer service/benefit processing experience
• Strong PC skills
• Analytical thinking
• Strong written and verbal communication necessary
• Strong knowledge of Medical terminology preferred
Benefits
• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement
Company Overview
• 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