[Hiring] Claims Audit Specialist @Versant Health

Role Description

The Claims Audit Specialist will lead quality reviews of work performed within Operations in accordance with the Departments guidelines. Analyze findings, report results and make suggestions on process improvements where common errors have been identified. Engage in the department or corporate projects in a continuous improvement environment to continually ensure that the work performed in these functional areas is accurate, complete, and improved.

• Responsible for conducting a quality review of functions performed
• Recommend corrections/changes to the systems, policies, and procedures, to ensure a higher quality of work performed
• Provide feedback to associates and management to improve how individuals and departments can improve workflow to eliminate repeated errors
• Assist the department Manager with conducting a routine review of the quality program to ensure it constantly meets business and regulatory requirements
• Provide regular feedback and recommendations to department Manager regarding staff performance and improvement
• Responsible for conducting quality reviews and maintaining documentation as mandated by control activity for SSAE 16 and Financial audits
• Assist in department/corporate projects, as assigned by department Manager/Director, in an effort to ensure that system upgrades, changes in policies, procedures or benefits are introduced into the department accurately and timely
• Other duties as assigned

Qualifications

• Preferred Bachelor's degree in related field or equivalent combination of experience and education
• One (1) year of related experience: Quality Review, Quality Assurance, or Process Improvement preferred
• Three (3) years of related experience in Claims required
• Bilingual skills a plus
• Proficiency in Microsoft Office

Requirements

• All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI)
• Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times
• Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program

Benefits

• Comprehensive and competitive total rewards package designed to support health, financial well-being, and work-life balance
• Medical, dental, and paid vision coverage
• Paid time off and company holidays
• Retirement savings with employer contribution
• Employee wellness resources
• Professional development opportunities
• Flexible work arrangements
• Employee assistance programs