Miramar, FL 33025
- Must be able to verify that claims are paid in accordance with correct contractual provision regulatory guidelines
- Knowledge of general processing for both health care providers and institutions
- Generate and utilize reports to perform “pre” and “post” audit for all examiners, at all level and to capture deficiencies in processed claims prior to check run.
- Must be able to work independently and successfully with limited supervision
- Must be able to work with Claims Examiners, give direction and answer claims related questions to improve overall quality of the department and individual examiners.
- Investigate, evaluate and resolve claims through the normal claim handling process. Achieve optimal results through proper litigation and vendor management. Review, analyze and provide opinions as to claim handling practices of claims handled by Third Parties.
- Representative claim audits typically include Professional Liability, General Liability, Excess, Auto, or Workers’ Compensation claims.
- Depending on experience and ability, the position may require project management responsibilities where the individual will direct and oversee audits and manage assigned auditors