Auditor, Delegate Claims
Alignment Health
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
Salary
💰 $70,823 - $106,234 per year
About the role
- Conduct audits in accordance with regulatory, contractual, and industry standards
- Execute detailed claims audits using established methodologies, sampling frameworks, and documentation standards to ensure accuracy, consistency, and regulatory readiness
- Communicate audit scope, expectations, and timelines clearly to delegated provider organizations throughout the audit lifecycle
- Review and validate Corrective Action Plans (CAPs) submitted by delegated entities to ensure remediation fully addresses identified deficiencies
Requirements
- 3-5 years of claims experience in an HMO, Medicare Advantage, and/or IPA setting
- 1-2 years minimum experience conducting oversight audits of delegated entities and/or ancillary providers
- Strong knowledge of Medicare audit processes and applicable state and federal regulatory requirements governing delegated claims operations
- High attention to detail with strong analytical and problem-solving capabilities to evaluate data, identify patterns, and determine root causes of issues.
- Advanced proficiency with Microsoft Office applications, especially Excel, Word, PowerPoint, and Outlook
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims auditingregulatory compliancedata analysissampling frameworksdocumentation standardsCorrective Action Plans (CAPs)Medicare audit processesproblem-solvingattention to detail
Soft Skills
communicationanalytical skills