**Job Summary:**
We are seeking an experienced Operations Auditor to join our team. The Operations Auditor will audit claims processed by Claim Examiners and provide feedback or approve claims processed as well as listen to calls taken by Customer Service and provide audits and feedback based on the phone calls. Ensure claims processed and calls taken are handled within the P&P and all appropriate information is provided.
**Responsibilities:**
· Audit calls taken by Customer Service.
· Audit claims processed by Claim Examiners
· Provide feedback to Claims and Customer Service personnel on audits
· Assist with explaining audits to individuals and conversations about how to improve
· Analyze and identify trends and provide reports as necessary
· Ensures compliance with all federal programs such as HIPAA and COBRA
· Provide feedback to the leadership team on audits and reviews of individuals
· Educate/Train internal staff as needed
· Maintain confidentiality and sensitivity in all aspects of internal and external contacts.
· Assist with expanding Policy and Procedures
· Review Summary Plan Documents and Plan Designs
· Testing of new Plan Designs
· Participate in meetings as required
Requirements and Skills
· At least two years Medicare Advantage Plan Experience
· Working knowledge of Microsoft products
· Excellent time management skills and ability to prioritize work
· Attention to detail and problem solving
· Excellent communication skills
· Knowledge of Health Insurance and knowledge of TPA Support
· Knowledge of Medicare Advantage, preferred
· Extensive Claims and Customer Service Knowledge with at least 5 years of experience
Job Type: Full-time
Pay: $25.00 - $30.00 per hour
Expected hours: 40 per week
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- Monday to Friday
- Weekends as needed
Work setting:
Experience:
- Medicare Advantage: 2 years (Required)
Work Location: Remote