CLAIMS AUDITOR SKILLS, EXPERIENCE, AND JOB REQUIREMENTS

The Claims Auditor possesses a comprehensive understanding of diverse disciplines and workflows, demonstrating flexibility and the willingness to travel 30-40% of the time across the United States to conduct thorough reviews. The role requires a high degree of self-motivation and discipline for detailed audit work, alongside strong communication skills and the ability to effectively convey audit findings to leadership in various profit centers. Additionally, This position's proficiency in Microsoft Office and other computer applications is essential, coupled with an ongoing commitment to professional development and maintaining a well-groomed appearance.

Essential Hard and Soft Skills for a Standout Claims Auditor Resume
  • Insurance Policy Analysis
  • Regulatory Compliance
  • Data Analysis
  • Financial Auditing Techniques
  • Risk Assessment
  • Medical Coding Knowledge
  • Legal Compliance
  • Claims Processing Software
  • Spreadsheet Proficiency
  • Statistical Reporting
  • Attention to Detail
  • Critical Thinking
  • Problem Solving
  • Communication
  • Negotiation
  • Organizational Skills
  • Integrity
  • Adaptability
  • Time Management
  • Decision Making

Summary of Claims Auditor Knowledge and Qualifications on Resume

1. BA in Accounting with 5 years of Experience

  • Experience in managed care or healthcare-related organizations with
  • Experience in claims processing and administrative appeal review experience. 
  • Experience with Medicaid claim processing preferred.
  • Knowledge of all aspects of claims processing, coding, A/R and reporting (Microsoft Word, Excel and Access). 
  • Able to demonstrate excellent verbal and written communication skills and analytical skills
  • Expertise in coding structure, ICD-9, ICD-10, CPT-4 and Revenue Codes
  • Understanding of provider and health plan contracting, delineation of risk, medical terminology and standard industry reimbursement methodologies
  • Knowledge and experience with dental insurance, dental claims submission and dental insurance reimbursement
  • Computer proficiency including Microsoft Office Suite, Google Drive, etc. and the ability to learn new programs.
  • Ability to collaborate and demonstrate a teamwork approach to job responsibilities
  • Ability to demonstrate initiative, dependability and promptness

2. BA in Business Administration with 3 years of Experience

  • Experience with maintaining confidential information.
  • Willing to work the necessary hours to complete projects.
  • Strong analytical skills and attention to detail.
  • Ability to perform work with little or no supervision.
  • Ability to communicate clearly, with proper grammar, both verbally and in writing.
  • Proficient use of MS Office applications and PDF documents.
  • Ability to deal with demanding customers in a tactful, professional manner.
  • Experience in short-term and/or Life insurance claims negotiation and handling
  • Experience in short-term and/or Life general insurance
  • Experience in claims handling and Auditing
  • Experience of SLA partners, UMA's and Binder Holders

3. BA in Finance with 2 years of Experience

  • Strong knowledge of property and casualty claims.
  • Experience in insurance claims.
  • Strong organizational, file management and time management skills.
  • Attention to detail and ability to prioritize.
  • Demonstrated focus on quality and continuous improvement.
  • Excellent written and oral communication skills.
  • Strong decision-making and interpersonal skills.
  • Adaptability and demonstrated ability to manage change.
  • Ability to work independently and in a team environment.
  • Analytical and strategic problem-solving skills.

4. BA in Economics with 4 years of Experience

  • An understanding of various disciplines and workflows.
  • Be flexible in schedule and be able to adjust on the fly to meet business needs.
  • A desire to excel and deliver industry-best audit execution.
  • A high degree of discipline and self-motivation while doing detailed audit work.
  • Strong written and oral communication skills
  • High degree of interpersonal effectiveness with a demonstrated ability to articulate review findings and case for change to leaders across various profit centers.
  • Ability and desire to pursue continued education through self-study and classroom instruction.
  • Well-groomed, professional and neat appearance.
  • Proficiency in computer applications including Microsoft Office Suite and ability to quickly learn new programs and agency management systems.

5. BS in Healthcare Administration with 4 years of Experience

  • Accurately correspond with patients and other team members verbally and via email
  • Excellent relationship and rapport-building experience with the ability to communicate clearly and present information with patients and other team members
  • Knowledge and experience with dental insurance, dental claims submission, and dental insurance reimbursement
  • Computer proficiency including Microsoft Office Suite, Google Drive, etc., and the ability to learn new programs.
  • Ability to collaborate and demonstrate a teamwork approach to job responsibilities
  • Ability to demonstrate initiative, dependability, and promptness
  • Experience with dental and vision claims 
  • Understanding of how to read an Explanation of Benefits and apply Coordination
  • Experience with claims auditing of SLA partners, UMA's and Binder Holders
  • Experience in general short-term and/or life insurance 
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