Sutherland
Sutherland
„Sutherland“ padeda organizacijoms modernizuoti veiklą ir klientų aptarnavimą pasitelkiant skaitmeninę transformaciją bei verslo procesų išorines paslaugas. Įmonės veikla apima dirbtinį intelektą, automatizavimą, debesijos inžineriją, skaitmeninę klientų patirtį ir įmonių technologijų sprendimus, taikomus sveikatos priežiūros, draudimo, kelionių, bankininkystės ir telekomunikacijų sektoriuose. Įmonės komandos daugiausia dėmesio skiria svarbiausių verslo procesų gerinimui, operatyvesnio bendravimo su klientais kūrimui ir pagalbai klientams prisitaikant prie technologijomis grindžiamos veiklos. Darbo ieškantiems žmonėms „Sutherland“ siūlo įvairių karjeros galimybių skaitmeninių paslaugų, klientų patirties, technologinių sprendimų diegimo ir išmaniojo automatizavimo srityse.

Senior Associate Health Claims Quality Auditor (Remote, New Jersey)

Review U.S. healthcare claims, including high-dollar billing, to find errors and potential fraud risks. Help improve claim quality and processes at Sutherland.

Aprašymas

  • Monitor performance and service quality to support customer satisfaction.
  • Communicate with clients and team members to understand needs, resolve issues, and meet expectations.
  • Share key information through timely, accurate reports.
  • Develop strategies using data, analysis, and observations.
  • Review healthcare claims for billing errors, discrepancies, and potential fraud.
  • Contribute to process documentation and quality improvement efforts.

Reikalavimai

  • Experience with U.S. healthcare and commercial and/or Medicaid claims processing.
  • Extensive experience handling high-dollar claims.
  • Knowledge of standard claim forms, including CMS-1500 and UB-04.
  • At least 2 to 3 years of direct experience in medical claims processing, medical billing, or healthcare auditing.
  • Ability to spot billing errors, discrepancies, and potential fraud.
  • Strong written and spoken communication skills.
  • Expert knowledge of complex commercial payer contracts, reimbursement methods, and federal Medicare and Medicaid regulations.
  • Experience documenting processes.
  • Proficiency with Microsoft Office.
  • Ability to work in a fast-paced environment.
  • Able to build trust and professional rapport with colleagues and contribute as a team member.
  • Strong analytical skills, including interpreting data, identifying trends, and recommending improvements.

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