Cambridge MA 02141 58 Charles Street
Job DescriptionThis 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 Magellan contracts in a consistent and accurate manner. Work closely with claims department to report issues and determine resolutions.
- Reviews benefit plans to ensure that claims are being adjudicated accurately and consistently according to Magellan 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.
General Job Information
Job FamilyOperations Group
CountryUnited States of America
FLSA StatusUnited States of America (Non-Exempt)
Recruiting Start Date1/24/2019
Date Requisition Created1/24/2019
EducationGED (Required), High School (Required)
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- 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.
- An understanding of the Magellan contracts, business and insurance principles related to claims adjudication.
- Experience with Magellan's multiple claim processing systems.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled