Customer Service Auditor

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

Job Summary
Perform audits and analysis information to measure corporate performance. Review business area records for the purpose of measuring accuracy of department processes within the WebTPA organization. The information will be used to determine individual and unit accuracy, as well as detecting any trends that may need to be addressed. This function will be closely related to the training function for the purpose of performance.

Essential Functions
The essential functions listed represent the major duties of this role, additional duties may be assigned.

• Perform audits on randomly selected claims, eligibility files, or calls, as determined by corporate audit procedures (60%)
• Organize audits to be performed on a regularly scheduled basis for all groups (10%)
• Review and summarize outcomes of audits with each department and present findings to appropriate management (10%)
• Maintain audit records (10%)
• Identify processes that need improvement and coordinate related training needs (5%)
• Follow up on performance issues to ensure corrective measures have been implemented (5%)
• Perform additional special audits as requested by management

Qualifications

• 3+ years related work experience in the appropriate department being audited
• High school diploma or GED
• Knowledge of CPT and ICD-9 coding required
• Knowledge of COBRA, HIPAA, pre-existing conditions, and COB required
• Extensive knowledge of revenue codes, subrogation, reinsurance contracts, and plan design implementation
• Knowledge of the fields on the HCFA, UB AND DENTAL form.
• Knowledge of entering Life claims, correspondence and appeal type of claims (data entry) Customized programs for Medical CPT coding

Preferred Qualifications

• Some college courses and/or a bachelor's degree desired.

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, Short- and long-term disability programs
• Leave programs to support personal circumstances.
• Retirement Savings Plan includes employer contribution and employer match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.