Job Details

A company is looking for an Auditor, Delegate Claims.Key ResponsibilitiesConduct detailed claims audits to ensure compliance with regulatory and contractual requirementsEngage with delegated provider organizations to correct deficiencies and improve performanceValidate the effectiveness of Corrective Action Plans (CAPs) and report audit findings for organizational awarenessRequired Qualifications3-5 years of claims experience in an HMO, Medicare Advantage, and/or IPA settingPrior experience in conducting oversight audits of delegated entities and/or ancillary providersDemonstrable knowledge of CMS claims compliance reportingHigh school diploma required; Bachelor's degree preferredStrong knowledge of Medicare audit processes and applicable regulatory requirements