Claims Auditor I, South San Francisco, CA
Claims Auditor I
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Claims Auditor I to perform review of claims processed by all areas of the Claims Department, log, track, and report all audit activity and provide information to the Claims Managers and others as required.
The essential duties and responsibilities will include the following:
- Perform review of claims processed by all levels of Examiners, claims processes, and claims transmitted via OCR.
- Handle responses/appeals to audit findings
- Log, track, and report all audit and productivity results and provide information to the Claims Managers and others as needed.
- Handle urgent and/or sensitive issues, including refunds, projects, and escalated calls and emails.
- Maintain working knowledge of policies and procedures for standard work processes in the Claims Department.
- Perform other duties as assigned
- This is a non-telecommuting position
Education and Experience: Two (2) years of experience in health claims processing/adjudication. A college degree in a health or business related fields is preferred.
Knowledge of: Medicare and Medi-Cal programs. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and Powerpoint.
Ability to: Work in a fast-paced, highly pressured, and changing environment. Analyze/evaluate information. Interpret policies and procedures. Produce basic logs and reports. Interact effectively with others and be a team player. Communicate efficiently orally and in writing. Able to organize workload.
Work independently, using sound judgement.
Compensation & Benefits
Starting Compensation Range: $20.99 to $28.86 per hour.
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, STD, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more. Check out our full benefits package at: https://www.hpsm.org/abouthpsm/employment-opportunities.aspx (Under Employee Benefits Tab)
How to Apply
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: firstname.lastname@example.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE