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Claim Operational Auditor

Company: Centene
Location: El Paso
Posted on: December 4, 2019

Job Description:

Claim Operational Auditor Position Purpose: Perform front end operational audits and assist in the development of value added feedback regarding the potential negative impact to claims accuracy. Investigate and report conflicts and/or variances of operational processing guidelines that are not compliant with state regulations and/or executed provider contracts. - Research statutory requirements and ensure compliance of all operations that impact claim accuracy. - Conduct audit interviews with front line staff in all functional areas that fall under claim operations. - Test, create flow charts and map operational processes that touch the outcome of claims accuracy. - Evaluate internal processes and/or controls to identify non-compliance issues and improvement opportunities. - Create audit memos to document audit findings, which will result in audit recommendations, reports and claims audit criteria enhancements. Education/Experience: Associate's degree in Audit, Accounting, related field, or equivalent experience. 2+ years of auditing or accounting experience. Knowledge of claims processing systems and the ability to interpret state and provider contracts. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Claims Operations USA-Texas-El Paso Superior HealthPlan Full-time

Keywords: Centene, El Paso , Claim Operational Auditor, Accounting, Auditing , El Paso, Texas

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