NJM Insurance Group

Process Auditor I

NJM Insurance Group

full-time

Posted on:

Location Type: Remote

Location: Connecticut • New Jersey • United States

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Salary

💰 $44,600 - $59,745 per year

Job Level

Junior

About the role

  • Provide resolution to identified overpayments utilizing various methods i.e., written correspondence, outbound call, or adjustment to a claim.
  • Research/adjust claims (i.e., Coordination of Benefits, no-fault, claim policy, authorizations, and referrals) in accordance with Plan contract provisions and all other governing policies and/or procedures.
  • Research and resolve Accounts Receivable (AR) issues to include the disposition of Cash Receipts in Universal Payment System (UPS).
  • Ensure accurate and timely resolution of service requests and activities is provided in accordance with the customer's health benefit coverage and company policy.
  • Anticipate and resolve potential issues and follow through on commitments made to the customers.
  • Coordinate with other areas within and outside of Service to address customers' inquiries regarding claim payment, benefits and/or appeals.
  • Follow up on unresolved issues via outbound calls, emails or faxes.
  • Share knowledge and information willingly with team members to achieve team, division, and Enterprise goals while enhancing service quality.
  • Submit provider file updates as appropriate.
  • Receive inbound telephone calls as they relate to recovery efforts.
  • Perform other related tasks as assigned by management.

Requirements

  • High School Diploma/GED required
  • 1 to 2 years customer service/benefit processing experience
  • Strong knowledge of Medical terminology preferred
  • Strong PC skills
  • Analytical thinking
  • Strong written and verbal communication necessary
Benefits
  • Comprehensive health benefits (Medical/Dental/Vision)
  • Retirement Plans
  • Generous PTO
  • Incentive Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Tuition Reimbursement
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
Accounts Receivableclaim processingCoordination of Benefitsno-fault claimsclaim policyauthorizationsreferralsUniversal Payment System
Soft Skills
analytical thinkingwritten communicationverbal communicationcustomer serviceproblem-solvingteam collaboration
Certifications
High School DiplomaGED