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Insurance Enrollment Auditor
Insurance Enrollment Auditor
CPS Recruitment has an exciting immediate need for a TEMPORARY Insurance Enrollment Auditor at a well-established healthcare company in Rochester, NY. (From August through the end of February) As an Insurance Enrollment Auditor the main duty is to perform audits to determine conformance with specified contract benefits, regulations and corporate policies. This temporary position is slotted to run from July until the end of the year, with possible temp-to-hire opportunity!
- Performs audits in accordance with State and Federal guidelines, client contracts, corporate policies and procedures and regulatory mandates
- Reviewing claims payments, customer service inquiries, and membership & billing transactions for all operating systems and servicing areas
- Evaluating and researching to obtain pertinent claim information including, but not limited to contacting physicians, facilities, groups, subscribers, and other insurance companies
- Proposes recommendations for workflow modifications, processing guidelines, system documentation and/or training documentation.
- Assists with the performance of external audits with direction from management
- Responsible for auditing and producing performance statistics for all performance guarantee groups for which the company has engaged in special contracts requiring external reporting to these groups
- Identifies trends and improvement opportunities
- Bring to the manager’s attention any ongoing problems that are detected while auditing – possible training or interpretational issues that are needed
- Acts as an information resource to the organization; conducts and participates in cross-training programs
- Adheres to and meets established deadlines as required by management.
- Intra-departmental reporting consisting of data input to document monthly work and performance measures
- Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures
- Performs intra-departmental reporting consisting of data input to document daily, weekly and monthly work and performance measures.
- AAS Degree in Business Administration or 6+ years’ equivalent work experience
- 3+ years’ experience in membership and/or billing enrollment experience necessary
- Strong Microsoft Excel skills highly desired
- Microsoft Access software experience a plus
- Effective communication and organizational skills
If this position is not for you, but for someone you know please feel free to forward this information. You are eligible for $50 if referred candidates are placed and complete the full assignment.
For immediate consideration please submit a resume in WORD Format to firstname.lastname@example.org
CPS Recruitment is an EOE
- Start Date:
- Pay Rate:
- $18.00 - 18.00/hour
- Rochester, NY 14647
- Job Type:
- Job ID: