Claims assistant Jobs in Syracuse, NY

Claims Audit Specialist

Provides support for claims audit activities including identification of incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.

Essential Job Duties

• Audits the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing of claims errors.
• Prepares, tracks and provides claims audit findings reports according to established timelines.
• Presents claims audit findings and makes recommendations to leadership for improvements based on audit results.
• Reviews timeliness of claims processing to ensure compliance with contractual and state / federal requirements.
• Maintains minimum claims audit accuracy rate per contractual guidelines.
• Supports claims department initiatives to improve overall claims function efficiency.
• Meets claims audit department quality and production standards.
• Completes basic claims projects as assigned.
• Experience in reviewing high $ claims, claims payment method.

Required Qualifications

Preferred Qualifications

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V