Sutherland organizacijam pomaga posodobiti način njihovega delovanja in zagotavljanja storitev strankam z digitalno preobrazbo in zunanjim izvajanjem poslovnih procesov. Njegovo delo združuje umetno inteligenco, avtomatizacijo, oblačno inženirstvo, digitalno uporabniško izkušnjo in tehnološke rešitve za podjetja, ki se uporabljajo v panogah, kot so zdravstvo, zavarovalništvo, potovanja, bančništvo in telekomunikacije. Ekipe podjetja se osredotočajo na izboljševanje ključnih poslovnih procesov, ustvarjanje odzivnejših interakcij s strankami ter pomoč naročnikom pri prilagajanju z uporabo tehnološko podprtih operacij. Za iskalce zaposlitve Sutherland ponuja različne poklicne poti, povezane z digitalnimi storitvami, uporabniško izkušnjo, tehnološko izvedbo in inteligentno avtomatizacijo.
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.
Opis
- 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.
Zahteve
- 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.