Delegation Oversight Program Auditor - Claims Processing

Elevance Health • Los Angeles, CA

6d • $69,736 - $87,170 • Hybrid

About The Position

This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law The Delegation Oversight Program Auditor - Claims Processor is responsible for completing limited and full desk reviews on providers in support of the regulatory Provider Oversight Program. Primary duties may include, but are not limited to: Performs audit work scoped by the desk reviews and acts the auditor in charge on small and less complex audits. Assists higher level auditor as assigned. Performs audits of Delegated Groups and providers as required by regulators, contracting, and internal management. Participates on audits of providers claims processing practices, claims payment records, and other projects including the review of the provider dispute resolution mechanism, and the corrective action plan process. Analyzes and interprets data and makes recommendations for change based on judgment and experience. Maintains the audit database and related reporting. Travels to worksite and other locations as necessary.

Requirements

• a BA/BS in Healthcare Management, Business Administration, or Finance and a minimum of 5 years of experience with claims practices audits; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• Claims Processing experience / California Claims for all lines of business strongly preferred.
• Experience reviewing/auditing claims process strongly preferred.
• Knowledge / Understanding of Delegation Oversight strongly preferred.

Responsibilities

• Performs audit work scoped by the desk reviews and acts the auditor in charge on small and less complex audits.
• Assists higher level auditor as assigned.
• Performs audits of Delegated Groups and providers as required by regulators, contracting, and internal management.
• Participates on audits of providers claims processing practices, claims payment records, and other projects including the review of the provider dispute resolution mechanism, and the corrective action plan process.
• Analyzes and interprets data and makes recommendations for change based on judgment and experience.
• Maintains the audit database and related reporting.
• Travels to worksite and other locations as necessary.

Benefits

• Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level