Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.Job Posting TitleClaims Auditor- REMOTEJob Description SummaryThis position supports management in the design, implementation, and maintenance of claims auditing programs. Responsible for auditing claims for accuracy. Verify that claims are being adjudicated according to Prime Therapeutics contracts in a consistent and accurate manner. Work closely with claims department to report issues and determine resolutions.Job Description
Reviews benefit plans to ensure that claims are being adjudicated accurately and consistently according to Prime Therapeutics contracts. Audits claims for financial accuracy.
Responsible for documenting and reporting issues found.
Assists with the establishment and updating of processes and audit manuals.
Identifies areas where issues exist and works with appropriate individuals to ensure resolution
Completes special focused audits as assigned by management.
Trains and mentors new auditors; works with trainers to audit and develop trainees.
Act as a resource for the auditing team.
Responsibilities
An understanding of the Magellan contracts, business and insurance principles related to claims adjudication.
Experience with Magellan's multiple claim processing systems.
An understanding of contracts, business and insurance principals related to claims adjudication.
Requires ability to read and understand benefit plans.
Experience with multiple claim processing systems.
Knowledge of coordination of benefit guidelines.
An understanding of the adjustment and resolution process.
Good interpersonal skills.
Must function independently with strong organizational skills.
Ability to handle multiple accounts and priorities.
Strong verbal and written communication skills.
Minimum 1 year health claims audit experience.
Work ExperienceWork Experience - Required:ClaimsWork Experience - Preferred:EducationEducation - Required:GED, High SchoolEducation - Preferred:CertificationsCertifications - Required:Certifications - Preferred:Potential pay for this position ranges from $18.87 - $28.30 based on experience and skills. Pay range may vary by 8% depending on applicant location.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.Prime Therapeutics LLC is a Tobacco-Free Workplace employer.Positions will be posted for a minimum of five consecutive workdays.Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.Prime Therapeutics LLC is a Tobacco-Free Workplace employer.If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.
