Talent.com

Senior auditor Jobs in Chula vista ca

Last updated: 9 hours ago
Claims Auditor

Claims Auditor

Prospect MedicalCA, United States
Full-time
Show moreLast updated: 29 days ago
  • New!
Senior Internal Auditor

Senior Internal Auditor

Atlas CorpCA
$83,900.00–$100,600.00 yearly
Full-time
Show moreLast updated: 9 hours ago
  • Promoted
Senior Source Code Auditor (Embedded Software)

Senior Source Code Auditor (Embedded Software)

InterEx GroupCA, United States
$120,000.00–$180,000.00 yearly
Full-time
Show moreLast updated: 19 days ago
Senior Internal Auditor II (Hybrid)

Senior Internal Auditor II (Hybrid)

IlluminaSan Diego, California , US
$105,600.00–$158,400.00 yearly
Full-time
Show moreLast updated: 30+ days ago
  • Promoted
Junior Internal Auditor

Junior Internal Auditor

Ignite Digital ServicesSan Diego, CA, United States
$75,000.00 yearly
Show moreLast updated: 26 days ago
Senior IT Auditor

Senior IT Auditor

Bio-RadCalifornia, United States, US
$114,700.00–$157,800.00 yearly
Show moreLast updated: 29 days ago
Senior Premium Auditor

Senior Premium Auditor

Howden Group HoldingsCalifornia, Remote
$110,000.00–$135,000.00 yearly
Remote
Full-time
Show moreLast updated: 30+ days ago
Senior Field Premium Auditor

Senior Field Premium Auditor

RICA Republic Indemnity Company of AmericaCalifornia, USA
$92,500.00–$98,000.00 yearly
Full-time
Show moreLast updated: 30+ days ago
Senior Information Technology Auditor (Hybrid)

Senior Information Technology Auditor (Hybrid)

SempraSan Diego, CA
$159,500.00 yearly
Full-time
Show moreLast updated: 30+ days ago
  • Promoted
HCC Auditor / Coder

HCC Auditor / Coder

Regal Medical GroupCA, United States
$25.00–$27.00 hourly
Full-time
Show moreLast updated: 6 days ago
Staff Auditor

Staff Auditor

Encore Capital GroupSan Diego, California
Show moreLast updated: 30+ days ago
  • Promoted
Senior Auditor

Senior Auditor

NASC GLOBALSan Diego, CA, US
$85,000.00 yearly
Full-time
Show moreLast updated: 13 days ago
Senior IT Auditor

Senior IT Auditor

Proven RecruitingSan Diego, California
Show moreLast updated: 29 days ago
Senior Cybersecurity Auditor (Hybrid)

Senior Cybersecurity Auditor (Hybrid)

San Diego Gas & Electric CompanySan Diego, CA
$109,500.00–$164,300.00 yearly
Show moreLast updated: 30+ days ago
  • Promoted
Internal Auditor

Internal Auditor

Generali Global Assistance | Travel InsuranceSan Diego, CA, United States
Full-time
Show moreLast updated: 13 days ago
Senior IT Auditor, IS Assurance

Senior IT Auditor, IS Assurance

BDOSan Diego, CA, United States
$80,000.00–$100,000.00 yearly
Full-time
Show moreLast updated: 30+ days ago
Senior IT Auditor

Senior IT Auditor

Bio-Rad Laboratories, Inc.California, United States
$114,700.00–$157,800.00 yearly
Show moreLast updated: 29 days ago
Senior Internal Auditor

Senior Internal Auditor

California Resources CorporationCalifornia, United States
$95,000.00–$115,000.00 yearly
Full-time
Show moreLast updated: 30+ days ago
Senior IT Auditor - Contract Farmers Insurance

Senior IT Auditor - Contract Farmers Insurance

KellyRemote, California, US
$62.00–$66.00 hourly
Remote
Temporary
Show moreLast updated: 30+ days ago
SENIOR PROGRAM AUDITOR, CALPERS

SENIOR PROGRAM AUDITOR, CALPERS

Public Employees Retirement SystemSacramento County, US
Show moreLast updated: 30+ days ago
Claims Auditor

Claims Auditor

Prospect MedicalCA, United States
29 days ago
Job type
  • Full-time
Job description

The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and / or inquiry processing experience to audit and analyze simple to advanced-level claims processing procedures and workflows.

Job Responsibilities / Duties

  • Apply claim processing experience to audit and analyze all levels of claims processing procedures and workflows. Requires the ability to audit claims accurately. Independently run reports on errors identified for potential error trends and report the results to Claims Management and Claims Trainer. Additionally assist in the processing of PDRs , Health Plan Cap Deducts, and claims processing.
  • Handle special projects from external provider and internal departments. Must have the ability to accurately make the necessary adjustments for underpayments and review overpayment requests for Claims Recovery Specialist.
  • Independently audit and analyze high dollar claims and checks prior to the issuance of funds. Must possess the ability to analyze Claims EOB and balance check amounts according to Claims processing guidelines.
  • Analyze and prepare Health plan claims selections for Annual health plan audit. Review samples provider by clerical staff and ensure claims payments are accurate and all documentations required by the health plan auditor is present at the time of audit.
  • Assist the Recovery Specialist in corresponding with external providers regarding Claims Overpayment requests. Requires the ability to communicate and analyze Claims processing methodologies according to CMS and DMHC guidelines.

Qualifications

Minimum Education : High School Diploma or Equivalent. BS / BA preferred.

Minimum Experience : Two to three (2-3) years previous experience as medical claims Auditor or 3-5 years previous experience examining medical Claims preferred. Preferably in an IPA, MSO, or Medical Group setting.

Req. Certification / Licensure : None