[Remote] Process Auditor I

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. Apply tot his job Apply To this Job