NJM Insurance Group

More Than 100 Years of Earning Trust

Process Auditor I

AuditorAuditorFull TimeRemoteTeam 1,001-5,000Since 1913H1B No SponsorCompany SiteLinkedIn

Location

Connecticut + 3 moreAll locations: Connecticut, New Jersey, New York, Pennsylvania

Posted

38 days ago

Salary

$44.6K - $59.7K / year

High School1 yr expEnglish

Job Description

• Provide resolution to identified overpayments utilizing various methods i.e., written correspondence, outbound call, or adjustment to a claim. • Research/adjust claims (i.e., Coordination of Benefits, no-fault, claim policy, authorizations, and referrals) in accordance with Plan contract provisions and all other governing policies and/or procedures. • Research and resolve Accounts Receivable (AR) issues to include the disposition of Cash Receipts in Universal Payment System (UPS). • Ensure accurate and timely resolution of service requests and activities is provided in accordance with the customer's health benefit coverage and company policy. • Anticipate and resolve potential issues and follow through on commitments made to the customers. • Coordinate with other areas within and outside of Service to address customers' inquiries regarding claim payment, benefits and/or appeals. • Follow up on unresolved issues via outbound calls, emails or faxes. • Share knowledge and information willingly with team members to achieve team, division, and Enterprise goals while enhancing service quality. • Submit provider file updates as appropriate. • Receive inbound telephone calls as they relate to recovery efforts. • Perform other related tasks as assigned by management.

Job Requirements

  • High School Diploma/GED required
  • 1 to 2 years customer service/benefit processing experience
  • Strong knowledge of Medical terminology preferred
  • Strong PC skills
  • Analytical thinking
  • Strong written and verbal communication necessary

Benefits

  • Comprehensive health benefits (Medical/Dental/Vision)
  • Retirement Plans
  • Generous PTO
  • Incentive Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Tuition Reimbursement

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