Job Details

Healthcare Claims Auditor

Company name
Arthur J. Gallagher & Co.

Location
Huntington Beach, CA

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Job Description

Arthur J. Gallagher & Co., one of the world's largest insurance brokers, provides a full range of retail and wholesale property/casualty (P/C) brokerage and alternative risk transfer services globally, as well as employee benefit brokerage, consulting, and actuarial services in the United States. We also offer claims and information management, risk control consulting, and appraisal services to clients around the world.

Arthur J. Gallagher Risk Management Services, Inc. is the U.S. retail property/casualty brokerage division of Arthur J. Gallagher & Co. Our advisors specialize by industry and coverage typesdeveloping solutions uniquely tailored to individual client requirements. We deliver a full range of insurance and risk management products and services, including traditional and loss-sensitive coverages, captives, alternative risk solutions, and financial products to clients around the world. For additional information, please refer to Career Opportunities with
Arthur J. Gallagher & Co.
Position Summary:

  • Receives and processes first reports of routine claims in accordance with company claims procedures and service standards.
  • Processes and run loss run reports and disseminate to appropriate staff.
  • Reports, monitor and actively manage claims for a timely, favorable resolution.
  • Analyzes coverage and advocates on behalf of clients.
  • Anticipates claims issues and effectively communicate with Account Executives, Claims Consultants/Advocates and others on potential issues, reserve increases and recommend alternatives to resolve disputes.
  • Actively researches claims data and communicate, coordinate, and monitor information with insured's and carrier adjusters for a timely resolution and in compliance with company service standards.
  • Assembles and organizes claim data to produce reports per client's request and satisfaction.

Additional Considerations:

  • Ideal candidates will have a working knowledge of the coding structure used in processing insurance claims, including CPT-4 Coding and HCPCS;
  • Knowledge of Excel including, but not limited to, basic formulas and spreadsheet maintenance
  • Claim auditing experience
  • Access and Applied systems (EPIC) experience
  • Knowledge of medical insurance terminology, including ICD-9, CPT, HCPCS coding; and place of service coding.
  • Knowledge of professional claim billing requirements including HCFA-1500, CPT codes and ICD-9; ICD-10 diagnoses codes. Hospital billing knowledge a plus.
  • Ability to read, interpret and apply material including benefits matrices, insurance policies and special codes.
  • Ability to analyze and audit if claims were paid correctly (according to contract, etc.)
  • Ability to prepare correspondence regarding claims payment and requesting information
  • Ability to effectively interact and establish a working relationship with customers, insurance carriers, and co-workers
  • Proficient with Microsoft office (particularly Word and Excel) and computer skills.
  • Excellent organizational skills with a strong focus on detail
  • Excellent verbal and written communication skills
  • Ability to interact and discuss audit results with clients and insurance carriers
  • Ability to multi task in a fast paced environment
  • Ability to organize, plan, prioritize and complete assignments within the required time frame

Required:

  • Bachelor's Degree
  • 3 or more years claim handling experience in a brokerage firm or in the insurance industry

U.S. Eligibility
Requirements:

  • Interested candidates must submit an application and resume/CV online to be considered
  • Must be 18 years of age or older
  • Must be willing to submit to a background investigation; any offer of employment is conditioned upon the successful completion of a background investigation
  • Must have unrestricted work authorization to work in the United States. For U.S. employment opportunities, Gallagher hires U.S. citizens, permanent residents, asylees, refugees, and temporary residents. Temporary residence does not include those with non-immigrant work authorization (F, J, H or L visas), such as students in practical training status. Exceptions to these requirements will be determined based on shortage of qualified candidates with a particular skill. Gallagher will require proof of work authorization
  • Must be willing to execute Gallaghers Employee Agreement or Confidentiality and Non-Disclosure Agreement which requires, among other things, post-employment obligations relating to non-solicitation, confidentiality and non-disclosure

Gallagher offers competitive salaries and benefits, including: medical/dental/vision plans, life and accident insurance, 401(K), employee stock purchase plan, educational expense reimbursement, employee assistance program, flexible work hours (availability varies by office and job function) training programs, matching gift program, and more.

Gallagher believes that all persons are entitled to equal employment opportunity and does not discriminate against nor favor any applicant because of race, color, religion, sex, age, veteran status, disability, national origin, or any other legally protected status. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

Company Description

Arthur J. Gallagher & Co., one of the world's largest insurance brokers, provides a full range of retail and wholesale property/casualty (P/C) brokerage and alternative risk transfer services globally, as well as employee benefit brokerage, consulting, and actuarial services in the United States. We also offer claims and information management, risk control consulting, and appraisal services to clients around the world.

Company info

Arthur J. Gallagher & Co.
Website : http://www.ajg.com

Company Profile
Risk management and benefits solutions should be about more than just placing coverage or selecting a plan. It's about growing your business and protecting your dreams. It's about ensuring your employees are properly engaged. Everyday our clients face massive challenges across a range of issues. Gallagher's advisors understand your business and how hard you work to deliver on your promises. We're your global partner in achieving your goals. And that only begins to describe the shared values, corporate culture and passion for excellence that define The Gallagher Way of doing business. Arthur J. Gallagher & Co. - the only insurance broker on the Ethisphere Institute's list of the World's Most Ethical Companies.

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