Careers

Career Opportunity with FCE Benefits Administrators

Quality Control Auditor - Claims

San Antonio, TX

Position Summary:

Primary duties of the QC Auditor will be to conduct audits to assess effectiveness of controls, accuracy of claims procedures and payments, efficiency of claim operations and to recover claim overpayments. Performs audits on claims that exceed processors authority limits, high dollar claims, and focused audits as needed. In addition, the QC Auditor will test and execute the audit plan for all assigned programs and departments.

Essential Job Functions:

  • Perform audit engagements of compliance and operational processes and controls. Identify control concerns, opportunities for improvement and best practices.
  • Apply audit experience to resolve basic audit elements.
  • Work with the audit team to implement suggested process improvements to improve department and individual performance.
  • Performs routine and moderately complex audits on individual, random, training and focused claims to identify exceptions to established claims adjudication requirements.
  • Researches claim processing problems and errors to determine their origin and appropriate feedback to processors, trainees and distribution to management.
  • Implements auditing guidelines and processes and creates policies and procedures.

Additional Duties:

  • Other duties as assigned.

Qualifications:

  • Minimum Education: High School Degree; Preferred: Bachelor’s degree in finance, accounting or healthcare related field.
  • Must have healthcare claims processing experience; Preferred: healthcare auditing, reviewing the validity and accuracy of claims data.
  • Working knowledge of insurance industry and medical terminology.
  • Expertise in Microsoft Excel®.
  • Experience in performing multiple projects and working with varying team members.
  • Must possess strong analytical skills. The ability to multi-task.
  • Must be familiar with ICD-10, HCPCS, CPT coding, ADA, and MS-DRG pricing.
  • Must be familiar with CMS, ERISA/DOL Regulations, facility and professional claim billing practices.

What We Bring To the Table

comprehensive benefit packages

We recognize that talented people are attracted to companies that provide competitive pay, comprehensive benefit packages, and outstanding advancement opportunities. For this reason, we offer a comprehensive benefits plan which includes the following:

  • Medical, Dental and Vision coverage
  • Disability Insurance
  • 401(K) Match
  • Flexible Spending Accounts
  • Health Saving Account Contributions
  • Fitness Membership Discounts
  • Company-paid Life Insurance
  • Tuition/Professional Development reimbursement
  • Employee Assistance Programs
  • Paid Time Off

How to apply

Please email resume, as an attachment, with cover letter, and salary requirements to: careers@fcebenefit.com

We are an equal opportunity employer.

It is FCE Benefit’s policy to provide equal opportunity employment for all qualified applicants and employees. FCE does not unlawfully discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), national origin, ancestry, age, physical or mental disability, legally protected medical condition, family care status, veteran status, marital status, sexual orientation, or any other basis protected by state or federal law or local ordinance. This applies to all areas of employment including recruitment, hiring, training, promotion, compensation, benefits, transfer, and social and recreational programs.

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