Claims Auditor - LH

Job description

At Luminare Health , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary: Job Purpose: This role is responsible for the evaluation, development, running, and/or providing testing updates. Scope of testing support includes project-driven enhancements, routine updates/requests for change and other enhancement activities where testing is deemed critical to Operational success, in adherence with company and industry quality standards. Role includes analysis of features/components/etc. and identification of enhancement opportunities. Job Responsibilities: - Pre-check run auditing on various reports prior to finalizing the check run. Works within timelines for auditing and manage all auditing according to schedule - Provide assistance with all Health Plan claim audits. Provide feedback to Management and Staff regarding auditing results - Complete Claims Appeals and 095 processes according to health plan and company guidelines in acc...