Health Claims Auditor
Diego-Martin or Westmoorings, North West
Full time
Posted On 12.23.2024
Expire On 01.24.2025 Employer
Description
Job Description:
Are you detail-oriented, analytical, and passionate about improving the healthcare industry? We are seeking a skilled Health Claims Auditor to join our team and help ensure the accuracy and integrity of healthcare claims. As a Health Claims Auditor, you will be responsible for reviewing, analyzing, and auditing medical claims to ensure compliance with policies, regulations, and industry standards.
JOB OVERVIEW:
The Health Claims Auditor will be responsible for professional level of health claims auditing work. This involves collating, reviewing and documenting documentation and reports related to RTA and Paper Health Claims; performing substantive audit procedures and other auditing techniques; analyzing trends and other audit findings and providing information to the Senior Health Claims Auditor. He/she works under the supervision of the Senior Health Claims Auditor with considerable latitude for independent judgement. He/she will also be required to travel both local and regional if the need arises.
JOB RESPONSIBILITIES:
1. Audit Planning
Are you detail-oriented, analytical, and passionate about improving the healthcare industry? We are seeking a skilled Health Claims Auditor to join our team and help ensure the accuracy and integrity of healthcare claims. As a Health Claims Auditor, you will be responsible for reviewing, analyzing, and auditing medical claims to ensure compliance with policies, regulations, and industry standards.
JOB OVERVIEW:
The Health Claims Auditor will be responsible for professional level of health claims auditing work. This involves collating, reviewing and documenting documentation and reports related to RTA and Paper Health Claims; performing substantive audit procedures and other auditing techniques; analyzing trends and other audit findings and providing information to the Senior Health Claims Auditor. He/she works under the supervision of the Senior Health Claims Auditor with considerable latitude for independent judgement. He/she will also be required to travel both local and regional if the need arises.
JOB RESPONSIBILITIES:
1. Audit Planning
- Gain an understanding of the process or area to be audited; conduct interviews/ walkthroughs; gather background information relative to the nature, purpose, volume, size, or complexity of automated systems, processes; identify risks to meeting business objectives and controls employed to mitigate those risks; perform data analytics, identify anomalies and select samples
2. Risk Analysis
- Identifying and analyzing potential issues that could negatively impact key business initiatives or critical projects in order to help organizations avoid or mitigate those risks.
3. Audit Testing:
- Develop audit tools and methodology to test and verify controls. Develop test scripts. Identify criteria for evaluating the test. Define a methodology to evaluate that the test and its results are accurate and repeatable.
4. Quality Assurance
- Conduct training within the department to aid in effective audit testing; review the audit testing performed by Audit team and compile and report urgent audit issues/findings to relevant internal and external stakeholders.
5. Communication of Audit Findings
- Throughout the audit, all issues identified are communicated immediately to various stakeholders to be addressed.
6. Documentation and Reporting
- Accumulate data, maintain records and reports on results of audit and other assigned activities.
7. To perform any other job-related duties as assigned by the Senior Health Claims Auditor/ Manager.
EDUCATION & EXPERIENCE:
EDUCATION & EXPERIENCE:
- 5 CXC/ CSEC passes Including Mathematics and English Language
- 2 A’ Level/ CAPE passes
- First Degree in Business, Management or Accounting from a recognized tertiary level educational institution.
- ACCA Level 2
- LOMA 280, 290, ACS 100 and all related parts
- Minimum two (2) years’ of full-time experience in auditing, accounting, business analysis or program evaluation or claims adjudication.
- Two (2) years insurance experience in the Health Insurance Industry.
ADDITIONAL REQUIREMENT:
- As a regulated entity with obligations under the Know Your Employee guidelines, a Certificate of Character is required.
PERSON SPECIFICATION:
The Health Claims Auditor must be vibrant and self-motivated. He/ She must possess strong interpersonal, communication, analytical and time management skills in addition to the ability to work under stress. He/she must be able to work with minimum supervision while completing multiple assignments and should demonstrate the ability to use initiative. The Incumbent must be decisive and must possess the ability to make effective decisions in a prompt manner.
Applications will be treated with the utmost confidentiality.
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Overview
Tags
Administrative-Clerical : Claims Processing, General-Other: Administrative-Clerical
Job Requirements
EDUCATION & EXPERIENCE:
- 5 CXC/ CSEC passes Including Mathematics and English Language
- 2 A’ Level/ CAPE passes
- First Degree in Business, Management or Accounting from a recognized tertiary level educational institution.
- ACCA Level 2
- LOMA 280, 290, ACS 100 and all related parts
- Minimum two (2) years’ of full-time experience in auditing, accounting, business analysis or program evaluation or claims adjudication.
- Two (2) years insurance experience in the Health Insurance Industry.
ADDITIONAL REQUIREMENT:
- As a regulated entity with obligations under the Know Your Employee guidelines, a Certificate of Character is required.
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