Provider Network Audit Quality Analyst

Description:
• Acts as an Advocate for, and support, the business by serving as a quality champion
• Performs routine quality audits for network operations and claim testing
• Conduct standard quality reviews /audits to measure compliance with published policies
• Identify and distribute errors to business partners
• Support the design and development of new processes
• Analyze and resolve complex claims scenarios within established time frames
• Respond to and resolves customer inquiries and complaints (internal as well as external)
• Analyzes and recommends solutions to non-standard requests and requirements from plan sponsors.

Requirements:
• 1-2+ years work experience in the audit environment that reflects a proven track record or proficiency in the competencies noted.
• Experience with claims testing, and a working knowledge of PPO’s.
• Experience with DG system.

Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
• Many other benefits depending on eligibility.