Sutherland palīdz organizācijām modernizēt savu darbību un klientu apkalpošanu, izmantojot digitālo transformāciju un biznesa procesu ārpakalpojumus. Uzņēmuma darbs apvieno mākslīgo intelektu, automatizāciju, mākoņtehnoloģiju izstrādi, digitālo klientu pieredzi un uzņēmumu tehnoloģiju risinājumus, kas tiek izmantoti tādās nozarēs kā veselības aprūpe, apdrošināšana, ceļošana, banku darbība un telekomunikācijas. Uzņēmuma komandas koncentrējas uz būtisku biznesa procesu uzlabošanu, atsaucīgākas saziņas ar klientiem veidošanu un palīdzību klientiem pielāgoties tehnoloģiju nodrošinātai darbībai. Darba meklētājiem Sutherland piedāvā dažādus karjeras ceļus digitālo pakalpojumu, klientu pieredzes, tehnoloģiju risinājumu ieviešanas un viedās automatizācijas jomā.
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.
Apraksts
- 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.
Prasības
- 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.