Claims Quality Auditor jobs in the United States

ABOUT UCARE

UCare offers Medicare, Medicaid, Individual and Family health plans – powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

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Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 14 consecutive years since the awards program began. It’s a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

Position Description

This position is responsible for conducting claim processing audits of claims services staff in accordance with Configuration & Claims Operations (CCO) department quality standards. Responsible to execute audits, track and report results, provide feedback to staff and participate in the audit rebuttal process.

• Maintain knowledge of all work instructions, job aids and relevant department policies across all products.

• Prepare, conduct, and analyze staff and leader claims audits to ensure technical competence. payment accuracy and compliance to department policies. Provide feedback and follow-up support as needed.

• Run daily reports and document and communicate audit results in a timely and consistent manner.

• Respond to audit rebuttals within 48 hours of receipt.

• Assist and provide feedback in the identification of process improvements to enhance claims processing quality, including the update of work instructions, job aids, department policies and/or staff training.

• Timely reporting of identified trends and/or system-related issues to Quality Control Manager.

• Act as subject matter expert supporting Claims Services Team, Trainers and other key stakeholders.

• Meet and maintain production and quality standards.

• Support training audits.

• Other projects and duties as assigned.

Education

Associates degree; demonstrated experience may be considered in lieu of degree.

Required Experience

Three years experience in medical claims processing. Knowledge of Commercial, Medicaid and Medicare insurance products.

Preferred Experience

Claims auditing experience. Amisys, HealthRules, Macess/EXP, and Microsoft Office knowledge and experience.

THE UCARE DIFFERENCE

The UCare difference is our people power – employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to .