Payment Integrity Specialist
Auditing payer claims across multiple lines of business, the full-time remote Payment Integrity Specialist will identify improper payments, quantify recoveries, and generate new audit concepts while maintaining high-quality standards and meeting monthly financial goals. Key responsibilities Audit payer claims to identify improper payments and recovery opportunities across various lines of business Analyze claims data to determine root causes of improper payments and build defensible audit findings Generate new audit concepts and recovery ideas based on patterns observed in the data Required qualifications 2+ years of experience at a payer or a payment integrity/audit vendor Hands-on experience with claims processing and payment integrity auditing Exposure across multiple lines of business, including commercial, FEP, Medicaid, and Medicare Strong analytical skills with the ability to identify significant problems in data Proficiency with Excel and ability to quickly learn new claims systems
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