Claims Auditor

Company Overview:

ASR Health Benefits is a rapidly growing third-party administrator of health plans, including medical, dental, vision, short-term disability, Section 125, and consumer-directed health plans.  We administer these health plans through dedicated client service teams, consisting of staff members from each department at ASR who work together to meet our clients’ needs.

ASR is currently seeking a Claims Auditor to join our Claims Department. We offer a dynamic work environment with opportunities for professional growth and development. At ASR, we follow a remote or hybrid work structure, allowing employees to work remotely and/or from the office based on specific tasks or personal work preferences.

Position Summary:

The Claims Auditor is responsible for reviewing claim benefits to ensure that claims are processed accurately and in compliance with company policies and procedures. The role involves verifying that claims are processed correctly based on various criteria such as employee/dependent eligibility, benefit application, coding accuracy, medical necessity, and compliance with the plan’s provisions. The Claims Auditor is also tasked with identifying overpayments, underpayments, and other discrepancies. The position requires coordinating with internal staff and external partners, particularly for large claims.

Key Responsibilities:

• Review claims to verify proper processing in accordance with company policies, including eligibility, coding, and compliance with benefits and exclusions.
• Conduct investigations into claims as requested.
• Identify and report error trends for training opportunities and process improvements.
• Facilitate weekly audit review meetings
• Collaborate with internal departments and external partners on large or complex claims.
• Provide exceptional customer service when interacting with both internal teams and external customers.
• Maintain a high level of accuracy and attention to detail in all audit tasks.

Requirements:

• Experience: Minimum of 2-3 years in claim processing, preferably within the TPA/Insurance industry.
• Knowledge:
• Familiarity with Claims processes and regulations such as Trilogy, ERISA, PPACA and COB regulations.
• Understanding of medical terminology and coding.
• Skills:
• High level of confidentiality required.
• Strong mathematical, problem-solving, and critical thinking abilities.
• Ability to work independently with high accuracy and attention to detail.
• Excellent verbal and written communication skills for both internal and external customer interactions.
• Strong organizational skills with the ability to prioritize and handle multiple tasks effectively.
• Proficient in Microsoft Office (Excel, Word, and Outlook).

Additional Requirements:

• Education: High school diploma or GED required.
• Must be willing to work overtime as needed, based on business or department needs.

If you are a motivated individual who thrives in a dynamic environment, with a passion for the insurance industry and building relationships, we encourage you to apply!

Please visit www.asrhealthbenefits.com and navigate to the CAREERS link on the homepage to view ASR’s current openings.

ASR is an equal opportunity employer committed to creating an inclusive environment for all employees.

No agencies please.