1 field claims representative jobs found in Sparks, MD

Position Summary The Quality Assurance Specialist is responsible for auditing and adjusting all healthcare claims to ensure accuracy, completeness, and compliance with internal policies and external regulatory requirements. This role enhances operational effectiveness by identifying training needs and recommending process improvements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role." Key Duties and Responsibilities Assists with the auditing and adjustments of all types of claims. Ensures the completion and submission of all required audit reports to management. Analyzes and identifies training needs based on audit results and system issues. Reviews and adjust a wide variety of claims to ensure accuracy, completeness, and compliance with established policies and procedures. Provides backup support for various claims processing and customer service functions as needed....