Claims Auditor

Conduct claims audits to ensure accuracy and integrity.

• •Centivo is seeking a Claims Auditor who will be responsible for conducting pre-payment, post-payment, and claims adjudication audits across multiple employer groups and product lines.
• •This role plays a key part in maintaining the integrity of our claims operations by supporting all aspects of the Claims Quality Review program.
• •Key Responsibilities Perform auditing of claims, ensuring processing, payment, and financial accuracy.
• •Complete reporting of audits finalized with decision methodology for procedural and monetary errors.
• •Identify and escalate trends based on the quality reviews.
• •Requirements Prior experience with a highly automated and integrated claims processing system, El Dorado-Javelina or Health Rules Payer (HRP) preferred.
• •Detailed knowledge of relevant systems and proven understanding of processing principles, techniques, and guidelines.
• •Strong analytical, organizational, and interpersonal skills.