Audit Description : does a weekly comparison between cost share applied in claims system (HR) and the expected cost share from our benefits source system (FOS) for finalized claims.
Comparison is based on the Benefit Provision in HR and the Benefit Details in FOS. UST will be provided with a sample of claims where cost share did not match the source system.
These claims will need to be reviewed for accuracy. We will also provide some samples where the cost share matched to verify this as well.
Responsibilities include, but are not limited to, the following :
Professional interaction with Nurses, Insurance Adjusters and other medical professionals.
In-take / Data Entry of Claims information.
Evaluation of benefits and eligibility.
Scanning, Uploading and labelling of case documents into the appropriate case files.
Collection, comparison, and review of medical files and documents.
Enables the clinician to plunge in to the review process of the document once queued by the Intake team
Skills and Qualifications
Any college education (degree is preferred). Graduate of allied health course an advantage.
At least 1 year of Healthcare BPO work experience specializing in claims.
Ability to multitask across multiple applications.
Strong analytical skills with excellent attention to detail
Great team player with excellent interpersonal skills