Key skills
Leadership
About this role
Role Overview
- The purpose of this job is to develop audit schedules based on best practices for procedural claims audits using various sampling methods
- Performs procedural claims audits based on various sampling methods
- Provides analysis and improvement planning based on audit results
- Conducts double reviews to ensure continuous calibration and consistent understanding and adherence to claims best practices
- Analyzes quality issues and provides feedback to stakeholders
- Develops audit schedules for the department
- Develops questionnaires and manages assessments for internal audit tools
- Oversees and prepares responses to all audits, whether internal or external
- Develop workflows and implement training for technical and non-technical employees to ensure operational integrity
- Plans, develops, and provides ongoing technical training and staff development programs
- Updates the claims procedures accordingly on the department’s SharePoint site
- Provides performance and skill assessments to managers and supervisors on an ongoing basis
- Collaborates with multiple employees on auditing, training and customer service issues for the department
- Partners with leadership to ensure service and quality levels are within standard operating procedures for the department.
Requirements
- High school diploma or General Education Degree (GED), required
- Bachelor's degree preferred
- Minimum 6 years of technical claims handling experience is required
- Prior audit experience is highly desirable
Benefits
- We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
- Bonus potential for all positions
- Paid Time Off
- Paid holidays throughout the calendar year
- Want to continue learning? We’ll support you 100%