Medical Plan Benefit Configuration AuditorCypress HCM • San Mateo, CA, US
Medical Plan Benefit Configuration Auditor
Cypress HCM • San Mateo, CA, US
[job_card.30_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
Job Description
Job Description
Medical Plan Benefit Configuration Auditor
Our client is looking for a meticulous and analytical Benefit Configuration Auditor contractor to join the Claims Quality Assurance team. In this role, you will be a vital safeguard, ensuring the company’s systems are configured flawlessly to match client benefit plans. You will protect plan assets, ensure compliance, and build trust by making sure every claim is paid right, every time.
What you’ll do:
- Drive Payment Integrity: Conduct comprehensive audits of the company’s system's benefit configuration against Summary Plan Descriptions (SPDs) and other plan documents to ensure perfect alignment and accurate claims processing.
- Ensure Coding and Regulatory Accuracy: Scrutinize medical claims for correct application of industry coding standards (ICD-10, CPT, HCPCs) and ensure the system configuration complies with all regulatory requirements, including ACA, ERISA, and other federal and state laws.
- Investigate and Analyze: Perform deep-dive, root cause analysis on high-volume claims data to identify trends, uncover configuration gaps, and pinpoint opportunities for improvement.
- Collaborate for Quality: Partner with internal teams, including Claims Operations, Configuration, Engineering, and Client Success, to test benefit rules, validate accumulator and provider contract setups, and communicate audit outcomes and remediation strategies clearly.
- Develop and Recommend Solutions: Translate your findings into actionable recommendations for the Benefits Configuration team. Help establish and document new standards, policies, and procedures to enhance operational excellence.
- Inform and Advise: Prepare and present clear, data-driven reports on audit findings, trends, and improvement initiatives for Leadership and other key stakeholders.
What you'll bring to the team:
- Deep Healthcare Claims Expertise: 3+ years of experience in medical claims processing and system configuration within a TPA or health insurance payer environment. You have a thorough understanding of adjudication workflows, payment policies, and compliance.
- Medical Coding Proficiency: A strong command of ICD-10, CPT, and HCPCs coding systems and their application in a payer setting. A solid understanding of medical terminology is essential. A Certified Professional Coder (CPC) or similar certification is highly preferred.
- An Analytical and Inquisitive Mindset: You excel at researching complex issues, analyzing data to find patterns, and thinking critically to solve problems. You're comfortable challenging the status quo to drive meaningful improvements.
- Exceptional Communication Skills: You can clearly and concisely articulate complex findings and recommendations to diverse audiences, from technical configuration teams to client-facing managers.
- A Meticulous Eye for Detail: You are highly organized and have an unwavering commitment to accuracy, even when managing competing priorities in a fast-paced environment.
- Comfort with Ambiguity: You thrive on creating clarity. You enjoy researching and developing consistent policies and are comfortable making well-reasoned decisions when clear answers aren't readily available.
Compensation: $30 - $42.50 per hour
ID#: 2463
[job_alerts.create_a_job]
Medical Plan Benefit Configuration Auditor • San Mateo, CA, US
[internal_linking.similar_jobs]
The Permanente Medical Group, Inc.Northern and Central California and an 80-year tradition of providing quality medical care.BE/BC OB/GYN Physician to join our team in San Jose, CA.Full-time annual...[show_more]
Compensation: Varies per assignment.Location: Remote (USA) Company: ProductReviewJobs Thank you for your interest in becoming a Paid Product Tester.This opportunity is for completing market researc...[show_more]
Your initial post of duty will be determined at the time of the final job offer and will be based on the operational needs of the U.Recruitment Incentive: Applicants may be eligible for a $40,000 r...[show_more]
Outset invented a better way to do research: AI-powered user interviews.Global brands like Hubspot, Microsoft, Uber and Nestle use Outset to achieve deeper, qualitative insights about their users a...[show_more]
Principal Software Engineer II.Snowflake is about empowering enterprises to achieve their full potential and people too.With a culture that's all in on impact, innovation, and collaboration, Snowfl...[show_more]
Accounting Clerk Job Responsibilities: Supports accounting operations by filing documents, reconciling statements, and running software programs.Maintains accounting records by making copies and fi...[show_more]
SUMMARY/JOB PURPOSE (Basic purpose of the job): Digital Marketing Director will be an integral part of the Exelixis franchise marketing team.Reporting to Executive Director of Digital Marketing, th...[show_more]
Live Your Best Life at Lap of Love Veterinary Hospice!.Join Lap of Love as an In-Home, Associate Veterinarian in San Jose.Imagine a veterinary role that honors your time, supports your well-being, ...[show_more]
Senior Wireless Software Engineer, WiFi.HP IQ is HP's new AI innovation lab.Combining startup agility with HP's global scale, we're building intelligent technologies that redefine how the world wor...[show_more]
Side Hustles � Flexible Work to Earn Extra Cash Looking to make extra money on the side? You don�t need to leave your full-time job to do it.With flexible side hustles, you can earn on your own sch...[show_more]
Join a locally owned Great Clips salon, the world's largest salon brand, and be one of the GREATS! Whether you're new to the industry or have years behind the chairgreat opportunities await!!.ELEVA...[show_more]
Sutter West Bay Medical Group has an opportunity for a BC/BE Neonatologist to join a premier, innovative, and rapidly growing group of providers.Our clinics provide all the advantages of a communit...[show_more]
Medical Interpreter 2, Spanish.The Medical Interpreter 2 position duties are to provide concise, objective, and accurate interpretation for Limited English Proficient (LEP) patients throughout UCSF...[show_more]
You have the power to make miracles for our families.If you’ve previously had a healthy pregnancy, you may qualify to help intended parents grow their family via IVF and receive $60,000-$100,000+ i...[show_more]
Senior Software Engineer, Data Infrastructure.Anthropic's mission is to create reliable, interpretable, and steerable AI systems.We want AI to be safe and beneficial for our users and for society a...[show_more]
The University of California, San Francisco (UCSF) and San Francisco VA Health Care System (SFVAHCS) are seeking applications for academic positions in the Pulmonary, Critical Care, Sleep, and Alle...[show_more]
DataAnnotation is committed to creating high-quality AI.Join our team to help train the next generation of AI while enjoying the flexibility of remote work and the freedom to set your own schedule....[show_more]
Together, we are the Epic Special Education Staffing family and family is how we view each member of this incredible community.From our family to the nation’s schools, we remain focused on providin...[show_more]
OB/GYN Physician in San Jose, CA
HealthEcareers - Client • Atherton, California, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Paid Product Tester
Product Review Jobs • MENLO PARK, CA, US
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Special Agent, $40,000 Recruitment Incentive
The United States Secret Service • Oakland, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Backend Software Engineer
Outset • San Francisco, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Principal Software Engineer II, Horizon Catalog
Snowflake Computing • Menlo Park, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Accounting Clerk
TradeJobsWorkforce • Berkeley, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Director, Digital Marketing
DiversityJobs Inc • Alameda, CA, United States
[job_card.full_time]
[last_updated.last_updated_1_day] • [promoted]
Mobile Veterinarian - Part time
Lap of Love • Redwood City, CA, US
[job_card.part_time]
[last_updated.last_updated_1_day] • [promoted]
Senior Wireless Software Engineer, WiFi
HP IQ • San Francisco, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Work From Home Gigs To Make Extra Cash!!
Gig Jobs • Orinda, CA, United States
[filters.remote]
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Hair Stylist - Woodside Plaza
Great Clips • Redwood City, CA, US
[job_card.full_time] +1
[last_updated.last_updated_variable_days] • [promoted]
SWBMG - Neonatology - East Bay
Sutter Health • Berkeley, CA, US
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Medical Interpreter 2, Spanish
University of California • San Francisco, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Help a Family Grow via IVF: $60,000-$100,000+ Compensation
The Genesis Group • Sausalito, CA, US
[job_card.full_time] +1
[last_updated.last_updated_variable_days] • [promoted]
Senior Software Engineer, Data Infrastructure
Anthropic • San Francisco, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Sleep Medicine - Physician
San Francisco VA Health Care System - Veterans Health Administration • El Cerrito, California, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Remote M&A Associate - AI Trainer ($50-$60 per hour)
Data Annotation • Richmond, California
[filters.remote]
[job_card.full_time] +1
[last_updated.last_updated_1_day] • [promoted]
Speech Language Pathologist Assistant School 2026-2027 SY
Epic Special Education Staffing • Vallejo, CA, US
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]