Risk Strategies is hiring a

Managed Care Auditor

Managed Care Auditor

REMOTE

United States

198884

Description

Risk Strategies is a top national specialty insurance brokerage and risk management firm assisting organizations and individuals to simplify the process of protecting assets, offering benefits and minimizing liability. With over 97 offices and 2,500 employees across the US & Canada, we thrive on our passion to be ranked a Best Places to Work since 2018 by our most important asset, our employees. For 2020, Risk Strategies was named 6th Fastest Growing Firm, 12th Largest Personal Lines Broker, 11th largest privately-held P&C Broker and the 16th largest US Broker by Insurance Journal.

Primary Responsibilities and Duties:

  • Analyze HMO Reinsurance and/or Provider Excess claims.
  • Identify and isolate the data that is specific to a particular claim submission.
  • Validate which expenses are eligible under the reinsurance contract.
  • Utilize pricing tools to determine the allowable portion of the eligible expense.
  • Accurately apply all deductibles and appropriate coinsurance(s).
  • Amend/revise pricing schedules, as needed.
  • Contribute innovative ideas and assist with the implementation of new processes

Requirements

  • Must have Advanced Excel Proficiency to include knowledge of Advanced Charting, VBA & Macros, Data Tables, Simulation & Solver, Index + Match, Advanced Formulae, PIVOT Tables & PIVOT Reporting, VLOOKUP and Conditional Formatting.
  • Minimum 2 years Claims experience with first dollar medical claims, specific and/or aggregate claims, HMO reinsurance and/or provider excess claims.
  • Prior experience with industry repricing methodologies. (Medicare, DRG, RBRVS etc.).
  • Demonstrated proficiency in Microsoft Office, to include Microsoft Access.
  • Demonstrated strong analytical/critical thinking skills; and detail oriented focus.
  • Strong written and verbal communication skills.
  • Ability to work independently with minimal supervision.
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