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Delta Health SystemsCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in auditing self-funded claims and customer service operations, with a strong understanding of claims processing and technical issues. Proficient in maintaining confidentiality and fostering professional relationships while providing analytical feedback to management.
Highest-signal resume keywords
Claims Processing ExperienceComputerized Claims Payment SystemsAnalytical SkillsOrganizational SkillsTechnical Claims Issues Understanding
About the role
Key responsibilities & impact- Audit self-funded Claims and Customer Service department work for accuracy according to established procedure guidelines
- Audit Claims, Customer Service and OA personnel
- Review and identify technical and system quality issues for claim processing, corr/recon, and customer service
- Document, maintain, and report audit statistics
- Accurately interpret claim policy, procedures, and standard group benefit provisions
- Provide feedback to management and reviewed employees regarding quality of work
- Maintain confidentiality of employee audits
- Adhere to company rules and regulations
- Maintain professional and productive relationships with peers, subordinates, and superiors
- Perform other duties as assigned
Requirements
What you’ll need- One year certificate from college or technical school; or one to three years related experience; and/or equivalent combination of education/experience
- Medical, dental and hospital claims processing experience
- Strong understanding of computerized claims payment systems, preferably at Delta Health Systems
- Excellent organizational skills
- Thorough understanding of technical claims issues and system edits
- Working knowledge of Microsoft Word and Excel
- Exceptional analytical skills
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AuditingTechnical Claims AnalysisStatistical ReportingPolicy InterpretationSystem Quality Issue Identification
Soft Skills
Professional Relationship ManagementFeedback ProvisionConfidentiality Maintenance
Tools & Technologies
Microsoft WordMicrosoft Excel
Certifications & Qualifications
One Year Certificate from College or Technical School
Industry Keywords
Self-Funded ClaimsCustomer ServiceDelta Health SystemsGroup Benefit Provisions