Job Description
Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey is a health solutions leader dedicated to improving healthcare quality and member experience. They are seeking a Process Auditor I to ensure excellent customer service by resolving inquiries from hospitals and managing claims adjustments effectively.
- Responsibilities
- Provide resolution to identified overpayments utilizing various methods i.e., written correspondence, outbound call, or adjustment to a claim
- Research/adjust claims (i.e., Coordination of Benefits, no-fault, claim policy, authorizations, and referrals) in accordance with Plan contract provisions and all other governing policies and/or procedures
- Research and resolve Accounts Receivable (AR) issues to include the disposition of Cash Receipts in Universal Payment System (UPS)
- Ensure accurate and timely resolution of service requests and activities is provided in accordance with the customer's health benefit coverage and company policy
- Anticipate and resolve potential issues and follow through on commitments made to the customers
- Coordinate with other areas within and outside of Service to address customers' inquiries regarding claim payment, benefits and/or appeals
- Follow up on unresolved issues via outbound calls, emails or faxes
- Share knowledge and information willingly with team members to achieve team, division, and Enterprise goals while enhancing service quality
- Submit provider file updates as appropriate
- Receive inbound telephone calls as they relate to recovery efforts
- Perform other related tasks as assigned by management
- Skills
- High School Diploma/GED required
- 1 to 2 years customer service/benefit processing experience
- Strong PC skills
- Analytical thinking
- Strong written and verbal communication necessary
- Strong knowledge of Medical terminology preferred
- Benefits
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
- Company Overview
- Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com.
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