Claims Auditor Cover Letter

I would like to submit my application for the claims auditor opening. Please accept this letter and the attached resume.

In my previous role, I was responsible for assistance to BU EHS leaders and controllers to ensure compliance with all applicable government policies/legislation and codes governing EHS aspect by facilitating any initiatives for development of policies and procedures.

Please consider my qualifications and experience:

• Act as subject matter expert and technical resource for the claims audit team and claims adjudicator
• Experience on the payer side (not billing) pricing claims and paying claims
• Proficiency in standard claims language
• Experience with the FACETS claims processing and the Macess EXP system preferred
• Thorough demonstrated knowledge of medical terminology
• ICD-9/ICD-10-CM coding
• Six Sigma Methodology experience (Green-Black Belt)
• Strong knowledge of claim processing

I am excited to be applying for the position of claims auditor. Please accept this letter and the attached resume as my interest in this position.

Previously, I was responsible for assistance to BU EHS leaders and operation safety controller (‘ OSC’ if applicable) to ensure compliance with all applicable government policies/legislation and codes governing EHS aspect by facilitating any initiatives for development of policies and procedures.

Please consider my qualifications and experience:

• Working knowledge of insurance industry and medical terminolgy
• Experience with Medicare/Medicaid auditing and quality control preferred
• Strong knowledge of facility claims preferred
• Demonstrated knowledge, skills & experience in applying the principles & practices of internal auditing in accounting, financial & operational environments, including auditing business functions & information technology systems
• Develops knowledge of the company, the healthcare and insurance industry and department goals
• Relevant previous work experience including but not limited to claims, service authorizations, health insurance, and Medicaid managed care products
• Determine if claim amount is correct
• IIA/CPCU designations are desirable, but not preferred

I submit this application to express my sincere interest in the claims auditor position.

In my previous role, I was responsible for diagnosis codes as necessary for Medicare Reporting.

Please consider my qualifications and experience:

• Strong claims technical background
• Good interpersonal skills and diplomacy
• A clear understanding of current Claim Departments processes and procedures preferred
• A working knowledge of various Unfair Claim Practice Acts preferred
• Knowledge of the principles of property and casualty insurance and the auto claims adjustment process preferred
• Intermediate skill levels in Microsoft Word, Excel, and Outlook preferred
• Working knowledge of claim processing procedures and guidelines
• Working knowledge of claim adjudication and benefit plan application for HMO plans, Medicaid specific knowledge preferable

I submit this application to express my sincere interest in the claims auditor position.

In my previous role, I was responsible for recommendations for addition or removal of supplier approval codes.

My experience is an excellent fit for the list of requirements in this job:

• Working knowledge of medical benefits and medical terminology
• Knowledge of commercial insurance provisions
• Experience with claims processing applications and business processes
• Knowledge of healthcare regulations and guidelines including
• BS Accounting or related field preferred
• Extensive knowledge of medical billing and coding practices
• Strong skills in organization, prioritization and attention to detail
• Previous experience in health claims audit, medical/healthcare billing or coding

I submit this application to express my sincere interest in the claims auditor position.

In the previous role, I was responsible for updates and educates Local government staff/officials and taxpayers on Model City Tax Codes, model options, local options; its related regulations, tax rulings and any applicable policies and procedures pertaining to the Model City Tax Code.

Please consider my qualifications and experience:

• To be able to focus on multiple projects
• Highly proficient in MS Excel and MS Word
• Requires specialized knowledge in the areas of contracts, Medicare Advantage, Medi-Cal HMO and commercial regulations and reimbursement rules and coordination of benefits
• Strong sense of individual responsibility and service to the customers and company
• Quality assurance program experience highly desirable
• Good working knowledge of HCFA, State of Ohio and Michigan compliance regulations, and institutional/professional ECS submission formats highly desirable
• Knowledge of HMO, PPO, Medicare and Medicaid plans -- including Medicare Advantage plans -- experience with Medicare Part D
• Advanced proficiency with PC applications such as Excel and Access