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Claims Audit Specialist

Company: Bind Benefits
Location: Minneapolis
Posted on: November 23, 2021

Job Description:

Bind was formed in 2016 by veteran health insurance innovators passionate about making health insurance personal - with the clarity, flexibility and power people deserve.

Want to move mountains?

Bind took the old model of health insurance apart and is rebuilding it - from floor to ceiling, from studs to rafters. We're not iterating a tired design or nudging a change-resistant industry, we're delivering what people want now - clear prices, timely support, personal choice and flexibility and an awesome, intuitive experience.

Where different wins.

Help build different and make a difference . Become a Binder and help us revolutionize health insurance.

Claims Audit Specialist


Bind is actively seeking a highly skilled, motivated, and experienced Medical Claims & Configuration Auditor to play a critical role in auditing the configuration of a new claim platform. In addition, you will support the ongoing auditing of medical claims processed in the system.

A Bind Claims & Configuration Auditor will partner with Technology, Operations, and Plan Design teams to ensure the Bind claim platforms align with the benefit plan.

Audit and testing of new business initiatives, benefits, and contract reimbursement configuration to ensure that the claims adjudication system is functioning according to business requirements
Develop best practices and standard operational procedures for quality assurance and the auditing of medical claims
Perform claims UAT on new and revised benefit and pricing configuration
Identify improvements in configuration auditing process to enhance quality and efficiency
Prepare and present monthly and quarterly audit reports to leadership
Review medical claims (Random, High Dollar, Focus) to measure standards and service levels are met and that claims are being processed according to the benefit Plan
Work with subject matter experts to resolve exceptions, review supporting documentation and make final claim error determination

A minimum of five (5) years' service as a medical claims' auditor and/or claim examiner in the health care field, preferably in the payer space
Deep understanding of payer operations, claim processing, and experience deploying a software product in the healthcare payer space
Excellent analytical skills with ability to read and understand complex data and make thoughtful, articulate recommendations
Excellent project management skills
Experience working as a liaison between business and technical teams
Knowledge of ICD-10, CPT, HCPCS, revenue codes and medical terminology
Demonstrated proficiency with Excel and SQL
Strong problem-solving skills and impeccable attention to detail
Knowledge and experience in a healthcare environment with HIPAA, ERISA and ACA requirements
Flexible and able to adapt to changing priorities and deadlines
Excellent communication skills, both written and spoken
A bachelor's degree in a related field or equivalent experience

Preferred Qualifications
Knowledge of state(s) insurance regulations
Startup experience
Working in an ambiguous, fast-paced environment
Agile, ready to change direction on the fly

What We're Offering
Empowerment to shape new solutions disrupting healthcare while providing benefits and choice to its members
Flexible work-from-home schedule to support work-life balance
Opportunity to work with people who are motivated to go to work every day and make a difference
Competitive pay, generous PTO, and the opportunity to be a part of a new health insurance plan powered by the consumer, you!

Diversity creates a healthier atmosphere. Bind is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Bind is a drug-free workplace.

Bind sponsors H-1B visas for current H-1B visa holders on a limited basis, other visa sponsorship not available.

Keywords: Bind Benefits, Minneapolis , Claims Audit Specialist, Accounting, Auditing , Minneapolis, Minnesota

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