Provider Network Audit Quality Analyst
Description:
- Acts as an Advocate for, and support, the business by serving as a quality champion
- Performs routine quality audits for network operations and claim testing
- Conduct standard quality reviews /audits to measure compliance with published policies
- Identify and distribute errors to business partners
- Support the design and development of new processes
- Analyze and resolve complex claims scenarios within established time frames
- Respond to and resolves customer inquiries and complaints (internal as well as external)
- Analyzes and recommends solutions to non-standard requests and requirements from plan sponsors.
Requirements:
- 1-2+ years work experience in the audit environment that reflects a proven track record or proficiency in the competencies noted.
- Experience with claims testing, and a working knowledge of PPO’s.
- Experience with DG system.
Benefits:
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
- Many other benefits depending on eligibility.
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