Claims Auditor I

Company Name:
ValueOptions, Inc., a Beacon Health Options company
ValueOptions, Inc., a Beacon Health Options company
ValueOptions is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled.
Position Location: NY - Latham
AAP Reporting Location: NY - Latham
ID: 32913
Job Family: Claims
Functional Area: CLAIMS
FTE Status: Full time
Scheduled Weekly Work Hrs: 40
Workday Schedule: Weekdays Only
Workday Start Time: 8:00
Workday End Time: 4:30
Variable Work Schedule:
We are currently seeking a dynamic Claims Auditor I to join our team at our office in Latham, New York The Claims Auditor I is responsible for auditing a percentage of processed claims for accuracy and reporting the findings to both the individual and management via a web based database.
Position Responsibilities:
1. Review a minimum of 85 claims per day (425/week) for HealthPlan and ESD processed claims; 65 claims per day (325/week) for Government Program processed claims to ensure accuracy in accordance with established policies and procedures in the CAS/SCC claims processing system on a daily basis
2. Review a percentage of claims in the SQA/RRI Mailroom module for accuracy in accordance with applicable policies on a daily basis
3. Report audit results and error trends to management.
4. Communicate training issues to management as identified through audits and adjustments.
5. Provide Professional, accurate and appropriate feedback to claims processors via the client audit database documentation system
6. Incumbent must maintain minimum number of claims reviewed on a daily basis as well as an industry standard refute overturn rate
Position Requirements:
Education: HS diploma or equivalent
Relevant Work Experience: Three to Five years relevant claims processing experience, preferably in a health care environment or a minimum of six months internal claims processing experience. Strong written and verbal communication skills.

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.