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Claim Operational Auditor

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

Job Description:

Description: 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.

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

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