University of Utah Health Care

  • Claims & Customer Service Auditor II

    Requisition Number
    30764
    Reg/Temp
    Regular
    Employment Type
    Full-Time
    Shift
    Day
    Work Schedule
    varies from 8am to 6pm
    Location Name
    University of Utah Health Plans
    Patient Care?
    No
    City
    Murray
    State
    UT
    Department
    UIP CST 01H UUHP OPERATIONS
    Category
    Insurance / Health Plans
  • Overview

    As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

    This position for use in Health Plans Departments only.

    This position is responsible for auditing claims and customer service calls for UUHP. The Claims and Customer Service Auditor reviews claims for processing accuracy in accordance with the benefit plan and contract information. They also audit customer service calls for demonstrated empathy, advocacy, and expertise.

    Responsibilities

    • Supports and promotes UUHP’s mission, vision, values, and goals.
    • Contributes to positive and productive team environment.
    • Performs routine and complex audits on phone calls and claims adjudication.
    • Researches claim processing problems and errors to determine their origin and appropriate resolution. Summarizes those findings in reports for management.
    • Ensures proper adjudication policies and procedures were followed as well as proper customer service expectations.
    • Processes claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
    • Provides prompt customer service to members, providers, billing departments and other insurance companies regarding claims.
    • Documents phone calls in system and follows up on issues if needed.
    • Resolves problems resulting from claim adjudication and customer service phone calls.
    • Researches claim overpayments and requests funds.
    • Handles escalated phone calls when supervisors are not available.
    • Involved in claim projects or escalated claim issues.
    • Shares knowledge with team members.

    Knowledge / Skills / Abilities

    • Demonstrates strong communication skills.
    • Ability to perform the essential functions of the job as outlined above.
    • Experience with claims processing in a health care delivery setting or insurance payer.
    • Customer service experience.
    • Ability to work effectively, independently, and as part of a team.
    • Strong organization, time management and project management skills and multi-tasking abilities.
    • Detail oriented with problem-solving abilities.

    Qualifications

    Qualifications

    Required

    • Associate’s Degree in health care administration, business, or equivalency.
    • Three years of experience as a Claims and/or Customer Service Auditor in a health care delivery setting or insurance payer with at least one of those years being a Claims and Customer Service Auditor I at University of Utah Health Plans.

    Qualifications (Preferred)

    Preferred

    • Customer service and claims processing experience in a health care delivery setting or insurance payer.
    • Knowledge of and experience with Medicaid, Medicare, and Commercial insurance.

    Working Conditions and Physical Demands

    Employee must be able to meet the following requirements with or without an accommodation.

    • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

    Physical Requirements

    Listening, Sitting, Speaking, Standing

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