Claims Auditor

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