Senior Auditor

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.

Essential Duties and Functions: Include the following.  Other duties may be assigned.

• This position reports to the Director of Audits.
• CTI’s Claim Administration Audit uses proprietary audit tools developed by CTI as well as Statistical Process Control techniques to identify opportunities for improvement in group health claim administration systems.
• The Senior Auditor reviews medical claims and determines if they have been paid in accordance with the plan document(s) and records their findings into CTI’s computerized audit system.
• CTI’s audits health, dental, vision, STD, and other employee benefit plans for primarily self-funded clients. The individual in this position will fulfill assigned responsibilities related to claim administration, customer service, and resolution of claim-related questions, complaints, and problems with a high level of accuracy and promptness.

Competencies and Principal Accountabilities:

• Familiarity with a wide variety of health care benefit plans and benefit plan provisions (e.g., pre-certification, case management, PPO’s, HMO’s, Consumer Driven Health Plans) and claim administration processes and systems.
• Strong analytical skills and knowledge of health care claim adjudication practices and provisions.
• Strong verbal and written communication skills.
• Strong computer applications skills and confidence to learn new applications.
• Knowledge of legislation affecting health insurance plans such as HIPAA, COBRA, Medicare, and ERISA.
• Accurate data entry and data verification capability.
• The Senior Auditor will provide expertise and assistance in researching and resolving complicated claims including appeals, subrogation investigations and adjustments.
• The Senior Auditor will support and assist the IT area in identifying system enhancements and improving the quality and productivity of the claim adjudication system.
• The Senior Auditor will travel for audits as necessary. Occasional travel expected.
• The Senior Auditor will follow the policies, procedures and operating standards developed by CTI.
• The Senior Auditor will maintain positive relations with all client contacts, insureds and vendors used by CTI.
• The Senior Auditor will continuously pursue professional designations intended to improve the quality and value of the services CTI provides.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Required: 

• At least 7 years of health care claim administration experience with some time spent in one or more of the following: medical claim examiner, medical claim adjudication, quality control, and benefit consulting.

Preferred:

• Professional certifications (e.g., Certified Fraud Examiner, AHIP, FLMI, CEBS)

Physical Requirements Necessary on a Regular Basis

Manual dexterity, arm and upper body range of motion sufficient for use of a keyboard, mouse and telephone 7-8 hours per day.

Speech and hearing sufficient for in-person and telephone communication 7-8 hours per day.

Vision sufficient for use of a computer monitor.

Ability to sit at a desk 7-8 hours per day.

We are an Equal Opportunity Employer. We take pride in the diversity of our team and seek diversity in our applicants.