Claims Fraud Analyst at BEST DOCTORS INSURANCE SERVICES LLC
, Florida, United States -
Full Time


Start Date

Immediate

Expiry Date

19 Dec, 25

Salary

0.0

Posted On

20 Sep, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Attention To Detail, Knowledge In Health Insurance Claims, Critical Eye, Bilingual, Experience Investigating Claims Payment Integrity, Understanding Of CPT, HCPCS, ICD-10, Experience Auditing Medical Claims, Data Mining, MS Excel

Industry

Insurance

Description
Job Details Job Location: Miami FL - Miami, FL Salary Range: Undisclosed Description We are seeking a diligent and skilled Claims Fraud Waste and Abuse Analyst to join our team at Best Doctors Insurance, a leading International private medical insurance provider. The successful candidate will play a crucial role in ensuring the integrity of claims payments, identifying potential fraud, waste, and abuse, and maintaining high standards of accuracy and compliance in health insurance claims processing. Analyze health insurance claims to identify potential fraud, waste, and abuse. Investigate claims payment integrity and ensure compliance with industry standards. Audit medical claims for irregular billing codes, including upcoding, unbundling, etc. Perform data mining on claims data to identify aberrant coding trends and potential fraud. Utilize CPT, HCPCS, and ICD-10 codes effectively in auditing and analysis. Prepare detailed reports and recommendations based on findings. Collaborate with other departments to ensure comprehensive fraud prevention strategies. Maintain up-to-date knowledge of industry trends and regulatory changes. Qualifications Attention to Detail: Meticulous approach to scrutinizing claims and identifying discrepancies. Knowledge in Health Insurance Claims: Proficient understanding of claims processing and payment integrity. Critical Eye: Ability to critically evaluate claims data to detect potential fraud. Bilingual (Spanish and English): Fluency in both languages is required. Portuguese proficiency is preferred. Experience Investigating Claims Payment Integrity: Proven track record in ensuring accurate claims payments. Understanding of CPT, HCPCS, and ICD-10: Thorough knowledge of coding standards and practices. Experience Auditing Medical Claims: Skilled in identifying irregular billing practices. Data Mining: Expertise in analyzing claims data to uncover trends indicative of fraud, waste, and abuse. MS Excel: Proficient in intermediate-level Excel functions for data analysis and reporting.
Responsibilities
The Claims Fraud Analyst will analyze health insurance claims to identify potential fraud, waste, and abuse while ensuring compliance with industry standards. They will audit medical claims for irregular billing codes and prepare detailed reports based on their findings.
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