Director of Claims Audit

A company is looking for a Director of Claims Audit.

Key Responsibilities

Lead the design and execution of internal claims audit activities, ensuring compliance with regulations

Oversee preparation of reporting packages for senior leadership and manage audit deliverables

Collaborate with cross-functional teams to implement corrective action plans and process improvements

Required Qualifications

10+ years of experience in health plan operations, claims auditing, or compliance

4+ years in a leadership role managing cross-functional teams or initiatives

Expertise in CMS regulations, SOX, and internal / external audits

Bachelor's degree in Healthcare Administration, Business, or related field; Master's degree preferred

Advanced analytical skills with experience in Excel, SQL, and data visualization tools