Collective Health

Auditor

• Create electronic claims accuracy monitoring mechanisms utilizing claims data models to identify potentially non-compliant claim adjudications.
• Develop and implement automated claims audits utilizing purposeful review of claims patterns and data analytics to proactively identify adjudication inaccuracies.
• Work cross-functionally with data analytics, data engineering, and other operational teams to identify and remediate claims errors based on data patterns.
• Audit medical claims received from providers for adjudication accuracy, including professional and institutional claims.
• Manage internal and external audits.
• Provide timely input on compliance-related issues and guidance requests.
• Assist with compliance risk assessments and audit readiness.
• Assist with new compliance regulation implementation related to claims accuracy.
• Collaborate with team members to identify and mitigate compliance risk for claims.
• Work closely with Collective Health attorneys to receive and coordinate legal guidance needed to operationalize important initiatives and requirements.

Senior Compliance Claims Auditor, Data

• Audit medical claims received from providers for adjudication accuracy. This includes both professional and institutional claims of all types
• Manage internal and external audits
• Provide timely input on compliance-related issues and guidance requests
• Assist with compliance risk assessments and audit readiness
• Assist with new compliance regulation implementation related to claims accuracy
• Collaborate with team members to identify and mitigate compliance risk for claims
• Work closely with Collective Health attorneys to receive and coordinate legal guidance needed to operationalize important initiatives and requirements

Senior Compliance Claims Auditor

Analyst

• Manage privacy incidents, including breaches, involving protected health information (PHI).
• Manage and trend privacy inquiries submitted by internal partners.
• Responsible for assisting with any third-party, privacy-based inquiries, audits or investigations.
• Responsible for assisting the Privacy Officer, Privacy Counsel and Senior Privacy Manager with operational aspects of the Privacy Program.

Senior Privacy Analyst

Growth Marketing

• Execute a go-to-market strategy to sell our health plan administration solutions directly to 'Payviders' (health systems that own or administer their own health plans) and support Sales in closing hospital customers
• Identify key decision-makers and drive the sales cycle of business development initiatives focusing on systems in need of operational efficiency
• Clearly articulate how our capabilities provide a competitive advantage and partner with product teams to advocate for new features that meet the needs of this market
• Work with Sales, Marketing, and other teams to ensure a unified go-to-market strategy and provide market feedback to improve service delivery
• Equip commercial and product teams with insight to support closing and onboarding provider systems clients
• Directly contribute to revenue growth by expanding distribution and bringing provider systems clients onto new channels, in partnership with cross-functional teams

Senior Director, Healthcare Markets and Growth

QA Engineer

• Lead comprehensive quality reviews of Member Claims Advocates' work, specifically targeting complex cases, high-dollar claims, and new hire performance to rigorously assess accuracy and decision-making.
• Manage and support responses to external audit requests, ensuring data integrity and compliance.
• Actively participate in Quality team meetings and calibration sessions, championing consistent scoring methodologies and a deep understanding of key metrics.
• Consistently maintain and strive to exceed an acceptable Claim Review Accuracy level.
• Contribute significantly to data-driven trend analysis, identifying root causes and actionable insights.
• Execute ad hoc claim reviews and perform in-depth deep-dive analyses to uncover systemic issues.
• Collaborate closely with Team Leads to develop and support training initiatives.
• Ensure strict adherence to all documented QA workflows and best practices.

Senior Compliance Claims Auditor, Data

Senior Compliance Claims Auditor

Senior Privacy Analyst

Senior Director, Healthcare Markets and Growth

Senior Quality Assurance Specialist, Member Claims