Claim Operational Auditor Job at Sunshine State Health Plan
You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Perform front end operational audits and assist in the development of value added feedback regarding the potential negative impact to claims accuracy. Investigate and report conflicts and/or variances of operational processing guidelines that are not compliant with state regulations and/or executed provider contracts.- Research statutory requirements and ensure compliance of all operations that impact claim accuracy.
- Conduct audit interviews with front line staff in all functional areas that fall under claim operations.
- Test, create flow charts and map operational processes that touch the outcome of claims accuracy.
- Evaluate internal processes and/or controls to identify non-compliance issues and improvement opportunities.
- Create audit memos to document audit findings, which will result in audit recommendations, reports and claims audit criteria enhancements.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Please Note :
www.epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, www.epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.