Lead Claims Auditor

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 TitleLead Claims AuditorJob Description SummaryThis position supports management in the design, implementation, and maintenance of claims auditing programs. Responsible for auditing claims for financial 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.Job Description

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.

Other duties as assigned.

Responsibilities

5+ years health claims audit experience.

An understanding of contracts, business and insurance principals related to claims adjudication.

Required 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.

An understanding of the Magellan contracts, business and insurance principals related to claims adjudication.

Experience with Magellan's multiple claim processing systems.

Work ExperienceWork Experience - Required:ClaimsWork Experience - Preferred:EducationEducation - Required:GED, High SchoolEducation - Preferred:CertificationsCertifications - Required:Certifications - Preferred:Potential pay for this position ranges from $22.84 - $34.25 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 an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.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 an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ​ 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.