POSITION SUMMARY/RESPONSIBILITIES
Responsible for the development and maintenance of a claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representative training needs that can be used to improve performance. Requires knowledge of claims processing for HCFA and UB92 for both commercial and Medicaid programs and knowledge of the CFHP claims payment processing system, Amisys.
EDUCATION/EXPERIENCE
A high school diploma or equivalency is required. Minimum of five years' experience in an insurance, medical or managed care environment, including two years of claim processing experience required. Previous auditing and/or Amisys experience preferred.