Analyst III - Actuarial Services
IEHP
SQL
Manager, External Audit
GEHA Health
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $112,963 - $159,237 per year
Job Level
Mid-LevelSenior
Tech Stack
SQL
About the role
- Lead audits and supervise claim audit team members and external third-party auditors.
- Conduct audit planning and supervise fieldwork ensuring compliance with Global Internal Audit Standards and G.E.H.A Internal Audit methodologies.
- Provide expertise in review, research, and analysis of claim exceptions; present audit findings and recommendations.
- Prepare and review draft audit reports with clear, constructive, actionable recommendations.
- Coordinate and oversee healthcare claim audits with third-party claim administrators and external claim auditors.
- Monitor open audit findings, remediation plans, and follow-ups; facilitate communications with internal/external partners.
- Perform quality review of workpapers and audit deliverables; lead postmortem sessions to capture lessons learned.
- Manage multiple projects, prioritize assignments, and proactively identify needs and solutions.
- Deliver training to less experienced team members and assist with Ad Hoc projects as requested.
Requirements
- Requires a college degree (BA/BS) from an accredited college/university.
- Requires 5 to 8 years of relevant audit and/or claim processing experience and 3 or more years of leadership experience.
- Analytical, research, and critical thinking skills with the ability to establish facts, define problems, draw valid conclusions, and develop solutions.
- Project, organizational, and time management skills to ensure projects are completed timely and on budget.
- Leadership skills with the ability to motivate, influence, and persuade.
- Verbal, written, and interpersonal communication skills and ability to address a wide range of audiences.
- Proficiency in Microsoft Office Applications (Excel is critical).
- Working knowledge of claims processing, medical terminology, medical codes, and reference materials.
- Knowledge of or experience with Claim system configuration, Claims (Medical/Dental), Enrollment, or Internal Operations functions.
- Ability to work independently, prioritize workflow, and exercise sound and independent judgment seeking guidance where appropriate.
- Preferred: Experience with data analytics software and tools preferred, i.e., IDEA, PowerBI, SQL.
- Work-at-home requirements: non-cellular High Speed Internet (min 30x5 Mbps), latency <80ms, no hotspots/satellite/wireless, dedicated space for PHI/HIPAA.
