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.

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