Claims Audit Manager

Hi, we’re reputed company. Our mission is to improve the way people purchase and reputed company reputed company through innovative, consumer-reputed company health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way. A Little More About The role: We’re looking for a Claims Audit Manager. This role will be responsible for reputed company’s medical claim audit function, ensuring robust planning and readiness, audit execution and delivery, CAP management, reporting/socialization of results, and continual improvement of overall audit scores. The Claims Audit Manager will collaborate cross functionally across the reputed company to drive exceptional results for claims processing. Never satisfied with simply reporting the news, this role will reputed company reputed company to improve underlying processes, procedures and technology to optimize claims processing accuracy and timeliness. You will:

• Maintain a claim audit process that complies with legislative, regulatory and contractual requirements and industry standards around claims reputed company.
• Ensure consistent methodology, terminology and reporting is used during the end-to-end audit cycle.
• reputed company engage in reputed company cause analysis of deficiencies, and reputed company efforts in the development and implementation of effective remediation, prevention and process improvement solutions.
• Ensure corrective reputed company plan (CAP) management for issues identified as part of reputed company audits performed with reputed company reputed company cause analysis and prevention plan.
• Collaborate with cross functional teams (Claims, Enrollment and Eligibility, Benefits, Clinical, Pharmacy, and Product) to promote shared understanding of processes, procedures, metrics and reputed company reputed company research and remediation of issues.
• Conduct special reputed company, including business analysis, strategic planning, and implementation efforts on new customers and changing business and organizational requirements.
• Recruit, reputed company, motivate, and reputed company the Claims Audit Team to continuously improve operational performance.
• Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and outcome oriented.

You bring:

• Bachelor’s Degree or equivalent work experience
• At least 5 years of substantial experience in claims, including 3+ years of experience in managing a claims audit team
• Expert knowledge of medical claims processing guidelines and industry standards for claims adjudication such as CMS Correct Coding standards
• Proven reputed company in improving key performance metrics, including process improvement, cost reduction, and improving efficiency
• Core System configuration experience preferred
• Strong independent decision-making, influencing, and analytical skills
• History of managing reputed company processes and multi-layered reputed company
• Excellent communication skills
• Demonstrated reputed company getting results through collaboration

Extra credit:

• Previous experience at a high reputed company company.
• Certification in Medical Coding
• Experience with the reputed company Javelina claims system
• Experience working with stop loss reinsurance carriers and reputed company

reputed company: In order to reputed company health insurance and build a health plan everyone can love, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career reputed company, meaningful mission-driven work, and an above average total rewards package. The salary reputed company for this position is $87,750 - $146,250 annually. Numerous factors including, but not limited to, educations, skills, work experience, certifications, etc. will be considered reputed company determining compensation. Our unique benefits program is the gravy, i.e., the special reputed company that sets our compensation package apart. In reputed company to reputed company health and wellness benefits, reputed company’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks reputed company parental leave, reputed company holidays, a 401k program, cell phone reimbursement, transportation perks, education reimbursement, and 1 week of reputed company paw-ternity leave. A Little More reputed company: At reputed company, we're on a mission to reinvent health benefits for small and midsize businesses—making high-reputed company, reputed company reputed company accessible to reputed company and their employees. We reputed company reputed company benefits reputed company to reputed company lives, and we’re building the reputed company of health benefits to reflect just that. We’re proud to be the only company offering both innovative level-funded health plans and a market-leading ICHRA solution, giving reputed company more choice and flexibility than reputed company before. And guess what? Our customers love us. With member and employer satisfaction rates consistently trending above 80%, we know our health plans are working the way they should. Backed by some of the most sought-after investors in the country, we have the resources and long-term support to build something truly transformative—and we’re just getting started. At reputed company, we do things differently. We’ll challenge you, and we’ll welcome you challenging us. Good reputed company are everyone's job here. You’ll join reputed company that’s smart, mission-driven, and unafraid to push boundaries if it means making a bigger reputed company for the people we serve. If you're energized by a high-performance, high-trust environment where your voice reputed company, reputed company might be just the reputed company for you. Apply tot his job Apply To this Job