Employer Industry: Healthcare Insurance

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Flexible, remote work environment
- Engaging in meaningful work that impacts the quality of claims processing and recovery
- Collaborative and supportive team culture
- Chance to enhance skills in claims auditing and compliance

What to Expect (Job Responsibilities):
- Conduct detailed audits of claims files to ensure accuracy and compliance with policies and regulations
- Identify and investigate claims for fraud, waste, and abuse (FWA)
- Coordinate recovery processes for potential overpayments or improper claims payouts
- Prepare audit reports and provide detailed findings and recommendations to management
- Collaborate with internal teams and external partners to resolve claims-related issues

What is Required (Qualifications):
- Bachelor's degree preferred, or an equivalent combination of work and educational experience
- 2+ years of experience with claims processing, auditing, or recovery in a healthcare, insurance, or financial services environment
- Proven analytical skills and attention to detail
- Proficiency in CPT, HCPCS, ICD-10, CMS, and Correct Coding Standards
- Strong relationship-building skills and proficiency in Microsoft Office Suite

How to Stand Out (Preferred Qualifications):
- Experience working in a remote environment
- Knowledge of industry regulations and best practices related to claims handling and recovery
- Ability to effectively communicate and train staff on compliance and claims processing best practices

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