Cotiviti, Inc.: Claims Resolution Specialist
Blue Bell, PA

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We’re looking for motivated, hardworking Audit Quality Specialists to join our growing Quality team in Blue Bell, PA. This role is an entry level position responsible for supporting a variety of objectives within the Audit Quality team. Under direct supervision, this person supports client requests, overpayment quality review, system reconciliation and Claim Audit requests. Documents relevant facts, information, and conclusions drawn to support the work performed so that supervisors may review and provide feedback.

Key Responsibilities:

  • Provides Specialized Audit Quality Support. Supports team supervisors in reliably completing client requests, data management needs, and overpayment record review. Assists supervisors in maintaining internal business systems as well as external client systems to ensure integrity, accuracy, and reliability. Lends support to specialists tasked with managing the claim overpayment rework queue as well as claim rework errors. 
  • Generates and Analyzes Quality Audit Reports. Provides support to supervisors to review and complete supplier quality audit reports initiated by the client. Documents system and process deficiencies identified through supplier quality audit work and communicates these deficiencies to supervisor. Communicates with client contacts and providers where necessary while following an established set of processes and procedures. 
  • Supports Process Improvement. Continuously analyzes processes and systems used during the course of work to identify internal areas of improvement and proactively communicates feedback to supervisors.

What we’re looking for: 

  • High School Diploma required. Bachelor’s Degree strongly preferred. 
  • Exceptional problem-solving, lateral thinking, communications, project management, planning, organizational and interpersonal skills. 
  • Strong technical skills, including proficiency in Microsoft Office (Word, Excel, Outlook) required; Microsoft Access experience preferred. 
  • Healthcare industry experience preferred. 
  • Strong interest in quality review and root cause identification/resolution. 
  • Ability to deal with personnel at all levels and exercise discretion on confidential matters. 
  • Excellent verbal and written communications skills. 
  • Ability to work well in an individual and team environment.
Full-time