California Licensed Health Plans Auditor
VirtualVocationsWorcester, Massachusetts, United States8 hours ago
Job type
- Full-time
Job description
A company is looking for a Specialty Health Plans Auditor III, Claims.
Key Responsibilities
Lead planning, execution, reporting, and corrective action monitoring for claims processing compliance across specialized health programs
Conduct annual claims audits and ensure compliance with regulatory and contractual requirements
Act as a Subject Matter Expert, mentoring staff and shaping best practices for continuous improvement
Qualifications
Bachelor's Degree in Accounting, Finance, or a related field, or equivalent education and / or experience
Minimum 5 years of experience in claims audits or claims processing related to managed care product lines
Demonstrated background in managed care, healthcare, or health insurance
Proven experience in healthcare claims audit and financial compliance
Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint)
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Health Plans Auditor • Worcester, Massachusetts, United States
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