Claims Auditor

Centivo(1 month ago)

HybridFull TimeMedior$52,000 - $60,000Operations

About this role

A Claims Auditor at Centivo is responsible for conducting comprehensive pre-payment and post-payment audits on claims across various employer groups, ensuring processing and financial accuracy in alignment with client standards. This role involves analyzing audit results, addressing quality issues with claim examiners, and contributing to the Claims Quality Review program through reporting, trend identification, and improvements in processing guidelines. Additionally, the Claims Auditor may participate in mentoring and training efforts while utilizing advanced claims processing systems like El Dorado-Javelina or Health Rules Payer.

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Required Skills

Claims Auditing
Quality Review
Claims Adjudication
Financial Accuracy
Quality Reporting
Trend Analysis
Communication Skills
Problem Solving
Process Improvement
Attention to Detail

+7 more

Qualifications

High School diploma or GED
Associate or bachelor’s degree preferred
Minimum of three (3) years of experience as a claim examiner and/or auditor with self-funded health care plans and processing in a TPA environment

About Centivo

centivo.com

Centivo is an innovative health plan designed specifically for self-funded employers, emphasizing the belief that everyone deserves quality healthcare at an affordable price. Founded with a focus on primary care, Centivo aims to provide plans that eliminate deductibles, offer free primary care, and maintain low, predictable copays for members. By centering care around established primary care relationships, the company strives to improve health outcomes while lowering overall medical costs. It serves employers, members, advisors, and providers, aiming to create a seamless and beneficial healthcare experience.