Claims Audit Analyst

At Welbe Health, we are transforming the reality of senior care by providing an all-inclusive healthcare option (PACE) to the most vulnerable senior population while serving as a care provider and care plan to those individuals we serve.

Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and accurate pre-payment or denial of claims while meeting federal/state regulations, provider agreements terms, and/or company policies and procedures.

• Review processed claims for accuracy prior to payment while maintaining acceptable levels of claim’s aged inventory by verifying various aspects of the system and claim
• Complete and maintain detailed documentation of audit findings which include decision methodology, system or processing errors, and monetary discrepancies
• Move claims free of processing errors through for full adjudication and return claims with errors back to the claims team for corrections
• Provide feedback to the Oversight & Monitoring Manager on claims processing errors, quality improvement opportunities, and configuration change requests, when applicable

• Minimum of three (3) years of experience processing and auditing Medicare and Medicaid professional, institutional, and dental health insurance
  
  Maintenance claims
• Experience working with CMS and Medicaid healthcare claims highly preferred
• Demonstrated skills within Microsoft Office Applications, including Excel

• Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
• Work/life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time
• Advancement opportunities - We’ve got a track record of hiring and promoting from within, meaning you can create your own path!
• And additional benefits

Salary/Wage base range for this role is $68,640 - $77,519 / year + Bonus. Welbe Health offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications.

Compensation

$68,640—$77,519 USD

At Welbe Health, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. Welbe Health maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

At Welbeashion We embrace and cherish the diversity of our team members, and we’re committed to building a culture of inclusion and belonging. We’re proud to be an equal opportunity employer. People seeking employment at Welbe Health are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

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