Position Summary
Independently conduct comprehensive audits to evaluate accuracy and compliance of various internal processes throughout the company as determined on a needs basis, a random rotational basis or to satisfy corporate reporting metrics.
Essential Functions and Job Responsibilities
• Conduct prescribed audits of claims processing accuracy to support the monitoring of performance standards.
• Perform defined audits of other operational processes to meet internal oversight, departmental and business objectives.
• Complete ad hoc audits, as needed.
• Evaluate audit results against internal processes and/or controls to identify areas of non-compliance and improvement opportunities; considering compliance with prescribed operational processing guidelines, policies, state and federal laws, executed contracts and DDPA requirements, as applicable.
• Clearly document identified audit findings in a timely manner for monitoring and escalation.
• Maintain files in accordance with management policies and guidelines by obtaining and attaching all appropriate documentation to clearly establish an audit trail for each audit performed.
• Conduct independent peer reviews to assess accuracy, completeness, and adherence to department standards and internal methodologies.
• Perform other duties as assigned.
Additional Functions
• Communicate clearly and concisely, with sensitivity to the needs of others.
• Maintain courteous, helpful and professional behavior on the job; display a willingness and ability to be responsive in a warm and caring manner to all other departments.
• Maintain confidentiality of company policies and procedures, audit results, and information about clients, members, providers, and employees.
• Establish and maintain effective and respectful working relationships with co-workers and members of other departments.
Qualifications
• High school diploma required. Some college coursework is preferred.
• Prefer three years of experience in operations auditing, or the health insurance industry to demonstrate a functional knowledge of insurance operations.
• Strong critical thinking and analytical skills.
• Possess effective verbal and written communication skills, including effective listening skills.
• Demonstrate strong organizational skills with proven attention to detail.
• Possess time management skills; exhibit solid ability to prioritize work and perform multiple tasks efficiently and timely.
• Able to work independently without close supervision.
• Must maintain confidentiality.
• Demonstrate integrity and honesty in all aspects of job performance.
• Maintain a professional demeanor in all communications.
• Able to communicate effectively with others across the organization.
• Working knowledge of Microsoft Office, including proficiency in Word, Excel and Outlook.
• Demonstrated commitment to the company’s core values of integrity, adaptability, service-focused, accountability, curiosity, and community.
Work Conditions
General office working conditions which may require sitting for extended periods of time
Physical Requirements
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Specific vision abilities require the ability to focus distant and near objects clearly. While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee is frequently required to use hands and arms to handle, feel and reach as well as operate a personal computer.
Disclaimer
This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties or responsibilities that will be required. The organization reserves the right to modify this job description at any time; including assigning or reassigning job duties.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.