Medical Claims Auditor

hace 1 mes


San Francisco, Heredia, Costa Rica Experian A tiempo completo

At Experian, we strive to simplify healthcare using data-driven insights. Our culture values openness, innovation, and accountability, making it an ideal place for a Medical Claims Auditor.

The role involves monitoring contractual allowances, analyzing appeal opportunities with payers and networks, and reporting appeals performance. Key responsibilities include:

  • Identifying under-allowed claims using software and other tools.
  • Reviewing EOBs for identified under-allowed claims.
  • Verifying applicable contracts through operational procedures.
  • Refining communication skills to prepare written and telephone appeals.
  • Compiling and submitting appeals, and monitoring for proper reimbursement.
  • Establishing helpful contacts in payer or network offices.
  • Preparing monthly performance statistics.
  • Maintaining confidentiality and providing continuous feedback.

To excel in this role, you will require:

  • A high school diploma with some university studies preferred.
  • 1-2 years' experience working with managed care claims and appeals.
  • Proficiency in Microsoft Office products, including Excel.


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