Medical Claim Lead Auditor

Irvine, CA - USA

Monthly Salary: $ 90000 - 98000

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Description

As a Medical Claim Lead Auditor you will apply your audit project management and client management skills to lead client audits. You will serve as the team leader and primary interface with administrators. You will review discrepancy issues identified by field auditors re-adjudicate claims resolve open issues and draft the final report. You will contribute to the creation of new tools and approaches.

The Responsibilities

Conduct pre-implementation and coverage specific audits and accurately document and record all audit findings
Understand clients plans and apprise team of unique provisions/issues prior to audit
Adjust workloads as necessary to achieve successful completion of project
Clearly communicate and professionally interact with vendor and audit team
Review documentation of potential discrepancies for thoroughness and accuracy
Resolve post-audit activities in an accurate and timely fashion
Write quality value-added draft report in a timely manner
Participate in client presentation of findings when requested
Understand vendors processes operating environment and specific challenges and take them into account with daily work
Develop working relationship with vendor counterparts
Distribute individual claim/work queues to team in a timely manner
Efficiently utilize audit-specific analytic techniques tools and processes
Ensure that Professional Excellence protocols are followed
Meet billable hours target
Seek opportunities to improve work processes and methods in pursuit of quality output and service delivery
Role will be working remotely within the posted locations.

Qualifications

5 years experience in health claims adjudication gained preferably in a consulting environment and/or in a major insurance claims administrator or health plan environment
Solid understanding of health and welfare plan design and all areas of claims administration as well as of vendors processes and operating environment
Familiarity with all plan types including consumer-driven PPO Indemnity and Managed Care
Must demonstrate a high level of claims administration knowledge including experience with medical dental mental health and Medicare
Detailed knowledge of ICD-10 and CPT codes and coding protocols
Excellent oral and written communications skills
Team player with strong work ethic
Self-directed; requiring very little supervision
Previous internal audit experience at a carrier or third-party external audit experience a plus
Bachelors Degree preferred; High School Diploma required

Qualifications

Compensation and Benefits

Base salary range and benefits information for this position are being included in accordance with requirements of various state/local pay transparency legislation. Please note that base salaries may vary for different individuals in the same role based on several factors including but not limited to location of the role individual competencies education/professional certifications qualifications/experience performance in the role and potential for revenue generation.

Compensation

The base salary compensation range being offered for this role is $90000 to $98000 USD per year.

This role is also eligible for an annual short-term incentive bonus.

Company Benefits

WTW provides a competitive benefit package which includes the following (eligibility requirements apply):

Health and Welfare: Mental health/emotional wellbeing (including Employee Assistance Program) medical (including prescription drug coverage and fertility benefits) dental vision Health Savings Account Commuter Accounts Health Care and Dependent Care Flexible Spending Accounts company-paid life insurance supplemental life insurance AD&D group accident group critical illness group legal identity theft protection wellbeing program adoption assistance surrogacy assistance auto/home insurance pet insurance and other work/life resources.
Leave Benefits:Paid Holidays Annual Paid Time Off (includes paid state/local paid leave where required) Short-Term Disability Long-Term Disability Other Leaves (e.g. Bereavement FMLA ADA Jury Duty Military Leave and Parental and Adoption Leave)Paid Time Off
Retirement Benefits:Contributory Pension Plan and Savings Plan (401k). All Level 38 and more senior roles may also be eligible for non-qualified Deferred Compensation and Deferred Savings Plans.

Pursuant to the San Francisco Fair Chance Ordinance and Los Angeles County Fair Chance Ordinance for Employers we will consider for employment qualified applicants with arrest and conviction records.

Note that visa employment-based non-immigrant visa sponsorship and/or assistance is not offered for this specific job opportunity.

This position will remain posted for a minimum of three business days from the date posted or until sufficient/appropriate candidate slate has been identified.

EOE including disability/vets

Required Experience:

DescriptionAs a Medical Claim Lead Auditor you will apply your audit project management and client management skills to lead client audits. You will serve as the team leader and primary interface with administrators. You will review discrepancy issues identified by field auditors re-adjudicate claim...

Description

The Responsibilities

Conduct pre-implementation and coverage specific audits and accurately document and record all audit findings
Understand clients plans and apprise team of unique provisions/issues prior to audit
Adjust workloads as necessary to achieve successful completion of project
Clearly communicate and professionally interact with vendor and audit team
Review documentation of potential discrepancies for thoroughness and accuracy
Resolve post-audit activities in an accurate and timely fashion
Write quality value-added draft report in a timely manner
Participate in client presentation of findings when requested
Understand vendors processes operating environment and specific challenges and take them into account with daily work
Develop working relationship with vendor counterparts
Distribute individual claim/work queues to team in a timely manner
Efficiently utilize audit-specific analytic techniques tools and processes
Ensure that Professional Excellence protocols are followed
Meet billable hours target
Seek opportunities to improve work processes and methods in pursuit of quality output and service delivery
Role will be working remotely within the posted locations.

Qualifications

5 years experience in health claims adjudication gained preferably in a consulting environment and/or in a major insurance claims administrator or health plan environment
Solid understanding of health and welfare plan design and all areas of claims administration as well as of vendors processes and operating environment
Familiarity with all plan types including consumer-driven PPO Indemnity and Managed Care
Must demonstrate a high level of claims administration knowledge including experience with medical dental mental health and Medicare
Detailed knowledge of ICD-10 and CPT codes and coding protocols
Excellent oral and written communications skills
Team player with strong work ethic
Self-directed; requiring very little supervision
Previous internal audit experience at a carrier or third-party external audit experience a plus
Bachelors Degree preferred; High School Diploma required

Qualifications

Compensation and Benefits

Compensation

The base salary compensation range being offered for this role is $90000 to $98000 USD per year.

This role is also eligible for an annual short-term incentive bonus.

Company Benefits

WTW provides a competitive benefit package which includes the following (eligibility requirements apply):

Health and Welfare: Mental health/emotional wellbeing (including Employee Assistance Program) medical (including prescription drug coverage and fertility benefits) dental vision Health Savings Account Commuter Accounts Health Care and Dependent Care Flexible Spending Accounts company-paid life insurance supplemental life insurance AD&D group accident group critical illness group legal identity theft protection wellbeing program adoption assistance surrogacy assistance auto/home insurance pet insurance and other work/life resources.
Leave Benefits:Paid Holidays Annual Paid Time Off (includes paid state/local paid leave where required) Short-Term Disability Long-Term Disability Other Leaves (e.g. Bereavement FMLA ADA Jury Duty Military Leave and Parental and Adoption Leave)Paid Time Off
Retirement Benefits:Contributory Pension Plan and Savings Plan (401k). All Level 38 and more senior roles may also be eligible for non-qualified Deferred Compensation and Deferred Savings Plans.

Pursuant to the San Francisco Fair Chance Ordinance and Los Angeles County Fair Chance Ordinance for Employers we will consider for employment qualified applicants with arrest and conviction records.

Note that visa employment-based non-immigrant visa sponsorship and/or assistance is not offered for this specific job opportunity.

This position will remain posted for a minimum of three business days from the date posted or until sufficient/appropriate candidate slate has been identified.

EOE including disability/vets

Required Experience: