Associate - Medical Claims

It’s more than just numbers.   

Miller Kaplan is a different kind of CPA firm; we believe in building a legacy—yours. We want to give our clients the very best, and we understand that begins with helping our employees be their best through professional mentorship, life-work integration, and a sense of community. That starts with you!

Job Summary:

The Associate – Medical Claims in the Claims Audit department is responsible for ensuring that medical claims, medical records, and other documentation essential to the healthcare industry are in compliance with federal and industry standards.

Supervisory Responsibilities:

• None.

Duties/Responsibilities:

• Audit medical, dental, and vision claims that have been processed by various insurance companies for multiple clients.
• Complete detailed summarized analysis audit reports within assigned budgets and deadlines. 
• Conduct analysis review of claims data and reconciliation data required for preparation of claims audits. 
• Process or audit claims for insurance carriers, third party administrators, or self-insured plans to ensure claims are processed in accordance with provider contracts and member benefits, compliance, and company policies and procedures.
• Research, document, and report audit error findings to clients. 
• Review and analyze error trends in processing. 
• Make photocopies; mail, scan, and email documents; and perform other clerical functions.
• Perform other related duties and projects as assigned.

Education and Experience:

Required:

• Associate degree in related field, but experience and/or other training/certification may be substituted for the education.
• Minimum five years’ experience in medical claims processing and/or auditing. 

Preferred:

• Bachelor’s degree in related field of study.

Required Skills/Abilities:

• Able to function well in a high-paced environment handling multiple priorities. 
• Able to work independently and as part of a team.
• Basic knowledge of ACA Guidelines.
• Excellent evaluation and reconciliation skills.
• Excellent written and verbal communication skills.
• Excellent organizational and time management skills.
• Flexible considering changing situations and circumstances.
• Proficient with Microsoft Office Suite or similar software.
• Knowledge of ICD-10, CPT 4, HCPCS codes and medical terminology.
• Must have experience and good understanding of COB rules, including Medicare regulations and PPO contracts.
• Strong customer service orientation.
• Strong data analysis proficiency using a variety of software package.
• Strong quantitative, analytical, and critical thinking skills.  

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at a time.
• 10% travel within the Los Angeles and San Francisco areas.

 

Benefits

LIFE:

• Competitive Salary: We value your dedication and hard work. We offer a competitive salary of $75,000 - $80,000 per year for this role.
• Generous Paid Time Off: Start with 20 days and watch it grow, plus 2 extra days annually for managers.
• Comprehensive Healthcare: Medical options include HMO, PPO, HDHP, with fully covered dental and vision for you.
• Flexible Spending Accounts & Health Savings Accounts: Manage healthcare expenses conveniently with a benefits debit card.
• Employee Assistance Program: Confidential support for personal or work-related challenges.

FAMILY:

• Hybrid & Remote Flexibility: Work-life balance matters! Enjoy flexibility based on your role.
• Insurance Benefits: Basic life insurance, voluntary life insurance, and long-term disability coverage.
• Dependent Care and Pet Insurance: Covering loved ones, furry or not, with flexible spending accounts and pet insurance.
• Bereavement Paid Time Off: Time to grieve and heal without work worries.
• Sabbatical and Personal Leave Options: Recharge and refocus with time off for personal needs.

BUSINESS:

• Social Events: Networking and unwinding at virtual and in-office firm social events.
• Referral Bonuses: Earn rewards for growing our team and client base.
• Commuter Benefits: Funds for transit and parking to ease your daily commute.
• Professional Development: Reimbursement for licenses, memberships, CPE allowance, and access to classes through Becker.

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