Auditor [h1.location_city]
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Auditor • winston salem nc
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Kohari Gonzalez Oneyear & BrownWinston Salem, NC, USInternal Auditor 2
TruistWinston, Salem, NCClaims Auditor
VirtualVocationsWinston Salem, North Carolina, United States- [job_card.full_time]
A company is looking for an Auditor, Delegate Claims.
Key Responsibilities
Conduct detailed claims audits to ensure compliance with regulatory and contractual requirements
Engage with delegated provider organizations to correct deficiencies and improve performance
Validate the effectiveness of Corrective Action Plans (CAPs) and report audit findings for organizational awareness
Required Qualifications
3-5 years of claims experience in an HMO, Medicare Advantage, and / or IPA setting
Prior experience in conducting oversight audits of delegated entities and / or ancillary providers
Demonstrable knowledge of CMS claims compliance reporting
High school diploma required; Bachelor's degree preferred
Strong knowledge of Medicare audit processes and applicable regulatory requirements