Auditor

• Determine adherence to quality standards through audits in the areas of expertise in Acquisition, Service and/or Benefits
• Maintain up-to-date expertise with relevant processes to provide an effective quality assessment
• Maintain a full audit workload and deliver high quality assessments
• Deliver concise, clear and professionally appropriate written documents
• Partner effectively with key stakeholders to identify holistic quality trends
• Identifying gaps in procedural documentation and work effectively with Policies and Procedures team to address
• Mentor new and existing staff in the QA I role
• Assist with QA projects
• Assists with regulatory and compliance inquiries as needed
• Establish and maintain collaborative working relationships with appropriate members of the operating areas
• May provide direct operational support due to critical business need

Quality Auditor II – Underwriting

• Conducts audits of the financial, management, and administrative procedures of assigned divisions, providers, departments, and various lines of businesses throughout the organization to ensure that procedures are in compliance
• Audits include interviewing key personnel, conducting testing, evaluating internal controls, analyzing existing financial and management practices to determine effectiveness, and reviewing relevant documentation to support findings
• Develops detailed reports on each audit conducted
• Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes
• Conducts testing of corrective actions as identified
• Conducts special audit studies for management, such as those required to discover controls for prevention of fraud
• Prepares reports of finding and recommendations for management
• Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel

Cost Auditor – Entry Level

Entry Level Cost Auditor

• Act as a local on-site program and company representative to residential customers
• Install energy efficient equipment, conduct energy efficiency (re)audits, pre- and post-installation verifications and other technical data gathering activities through a defined territory
• Support Program Managers in their efforts to influence stakeholders to sell and/or install energy efficiency and demand response retrofits or services
• Provides technical advice, guidance and training on installation, adaptation, configuration or enhancement in accordance with client specifications
• Troubleshoots technical problems and issues and recommends solutions
• Establish and build relationships with residential customers and contractors ensuring that necessary energy efficiency measures are properly installed to standards and on-time
• Record and track contractor interaction and verify that installations achieve required program savings
• Inform, educate, and train contractors about the program
• Provide individualized and ongoing assistance to property owners and contractors to convert projects according to contract compliance
• Document customer and contractor interactions to adhere to program requirements
• Provide input and status updates to program staff
• Act as local, on-site program and company representative to customers and contractors; to encourage participation in the program and overcome barriers.

Residential Energy Auditor

• Conducts audits of the financial, management, and administrative procedures of assigned divisions, providers, departments, and various lines of businesses throughout the organization to ensure that procedures are in compliance.
• Audits include interviewing key personnel, conducting testing, evaluating internal controls, analyzing existing financial and management practices to determine effectiveness, and reviewing relevant documentation to support findings.
• Develops detailed reports on each audit conducted.
• Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes.
• Conducts testing of corrective actions as identified.
• Conducts special audit studies for management, such as those required to discover controls for prevention of fraud.
• Prepares reports of finding and recommendations for management.
• Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel.

Auditor I

• Conducts audits of the financial, management, and administrative procedures of assigned divisions, providers, departments, and various lines of businesses throughout the organization to ensure that procedures are in compliance
• Conducts interviews with key personnel
• Conducts testing, evaluates internal controls, analyzes existing financial and management practices to determine effectiveness, and reviews relevant documentation to support findings
• Develops detailed reports on each audit conducted, including a review of findings and recommendations to correct deficiencies and improve processes
• Conducts testing of corrective actions as identified
• Conducts special audit studies for management to identify controls for prevention of fraud
• Prepares reports of findings and recommendations for management
• Assists other auditors in completing their assignments to maximize audit efficiency

Auditor I, CGS

• Collaborate with audit team members as well as members of IT to develop audit objectives, engagement scopes, and testing strategies aligned with departmental standards and risk priorities.
• Assist in the planning, execution, and reporting of IT audit engagements, including SOX ITGC testing, risk-based technology reviews, and issue validation procedures.
• Analyze and summarize data to identify control deficiencies, process inefficiencies, or noncompliance with policies, procedures, or regulations.
• Communicate findings and recommendations to audit leadership and business stakeholders in a clear manner.
• Monitor issued audit findings, perform validation testing over defined remediation plans, and present remediation statuses to stakeholders.
• Identify opportunities to strengthen controls, improve operational effectiveness, and reduce risk exposure across technology and business processes.
• Other duties as assigned

IT Auditor I

• Conduct virtual audits of selected commercial lines policies by reviewing the customer’s business operations, including examining, verifying, and recording pertinent classification-related data from financial business records.
• Ensure quality of the audit through proper risk classification and exposure basis identification.
• Utilize laptop computer to record audit information provided by the Premium Audit Service Representative and to transmit completed audits in a timely manner.
• Discuss issues and problems with insureds to ensure understanding of the change in premium and to maintain good customer relations.
• Provide external customers (i.e., agents and insured’s) and internal customers (i.e., underwriting, claims, and accounting) with information to assist in their understanding of audit-related matters, including audit statements, procedures, and worksheets.
• Remain informed of changes and current information relative to premium auditing through discussions with industry experts and review of industry related literature.
• Exhibit excellent time management skills and can work from a home office with minimal direct supervision.
• Conduct business in a professional manner to conserve and protect the corporate assets of Builders Mutual.
• Work on special projects and assignments as required, in addition to regularly scheduled work.
• Share information and experiences with less experienced virtual premium auditors.

Premium Auditor

• Acts as the liaison between key client contacts and our denials and underpayment appeal process to the appropriate payer.
• Responsible for facilitating payment review recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing the department's revenue.
• Responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.
• Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, and other assigned claims.
• Use payment documentation provided by payers and medical provider contract information to determine the correct reimbursement.
• Efficiently review hospital contracts to identify and collect cash payments from insurance companies.
• Research, request, and acquire all pertinent medical records and supporting documentation to create and submit complex underpayment appeals.
• Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received.
• Ensures smooth operations and improves customer satisfaction.

Zero Balance Auditor

• Prepare, manage, and audit all primary and secondary insurance verifications and re-verifications for medical insurances such as Medicare, Private and Managed Care patients via paper or electronic means according to payer specific rules.
• Responsible for pre-billing audits, inputting and maintaining the daily client lists and pre-billing audits in the Accounts Receivable (AR) or other financial software systems.
• Accurately maintain all patient accounts including monthly statements and collections.
• Research and resolve EOB rejections and other issues with outstanding accounts.
• Post cash receipts and adjustments as needed.
• Facilitate initial and ongoing authorizations from patient insurances.
• Review contracts to verify insurance payment and insurance requirements.
• Assist facilitating and managing the Monthly Triple Check process.
• Assist in maintaining payer setup in the AR software.
• Communicate with managers and staff as required to obtain or verify billing information.
• Communicate with patients and/or families regarding patient data and account status.

Medical Billing Auditor

• Build and maintain strong relationships with key business stakeholders to support audit engagement success
• Independently assess functions and activities to evaluate operational effectiveness and control adequacy
• Plan and scope audits that align with organizational priorities and risk profiles
• Analyze complex data and evidence to form objective, actionable insights
• Communicate findings clearly and persuasively to senior leadership
• Prepare high-impact audit reports tailored to stakeholder needs
• Monitor finding remediation efforts and provide strategic guidance on risk mitigation
• Serve as a subject matter expert and escalation point for complex issues
• Mentor junior team members, fostering a culture of excellence and continuous improvement
• Contribute to cross-functional initiatives and strategic projects

Senior Internal Auditor – IT

• Lead operational and integrated audits, delivering actionable insights that enhance risk management and control effectiveness.
• Guide audit teams through all phases of engagements, including planning, fieldwork, and reporting.
• Develop risk-based audit programs and evaluate organizational activities to ensure compliance and efficiency.
• Report findings to senior management and partner on corrective actions and process improvements.
• Collaborate with cross-functional teams to resolve complex issues and strengthen internal controls.
• Support audit managers with project administration and timeline development.
• Leverage data analytics to identify trends and improve audit outcomes.
• Build strong relationships with stakeholders to promote transparency and trust.

Senior Internal Auditor

• Develops and implements strategic needs analyses and training plans for coding leadership
• Coordinates and evaluates curriculum development
• Conducts the preparation and delivery of training for Medical Coders
• Provides guidance and leadership to coding and billing management
• Performs annual performance reviews and quality assurance reviews
• Serves as a subject matter expert for professional fee coding
• Ensures information meeting professional coding standards is accurate and current
• Monitors and audits inpatient and outpatient accounts
• Assesses educational needs of coding staff
• Develops programs or researches educational resources
• Assists with training new and existing staff
• Coordinates the presentation of ongoing professional seminars and materials
• Performs miscellaneous job-related duties as assigned
• Provides reports of audit findings to coding management and leadership

Physician Coding Auditor

• Identifying issues and/or entities that may pose potential risk associated with fraud and abuse
• Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control
• Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations and continue to next step in the claims lifecycle
• Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations
• Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern
• Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation

Clinical Provider Auditor I

• Prepare audit pre-work via prescribed method and more broadly as required.
• Prepare pre-work communications, documents.
• Monitor items requiring post-audit follow-up.
• On-going maintenance of pre-work schedules.
• Assemble pre-work data in pre-determined format for RFA review and inclusion in final audit packet.
• Assist with RFA requests for supporting documentation as required.
• Assist with preparation & planning of investigative efforts.
• Liaison with other departments to streamline pre-work assembly, research and post-audit follow-up efforts.
• Prepare analysis and queries as directed.
• Identify, maintain a schedule of HC undergoing office replacement or remodel.
• Identify, maintain schedules of pertaining to special aspects of audits.
• Follow-up on findings when necessary.
• Log special circumstances for use in pre-work stage of audit.
• Log, track other HC metrics and timelines as identified.
• Assist with integration of various audit results/findings into the current audit plan.
• Serve as a central point of coordination for pre-fieldwork logistics, readiness tracking, and information flow between field auditors and operational stakeholders.
• Ensure field audit teams arrive onsite with complete background materials, validated data sets, and clearly defined operational focus areas.
• Provide ongoing off-site support during fieldwork by responding to follow-up data or documentation requests.
• Assist in research of new data analytics and tools including helping to validate those evolving tools.
• Research red flags to provide the Auditors with information to facilitate their ongoing and upcoming auditors.

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