Claims Delegation Oversight Examiner

SummaryJob DescriptionThe Claims Delegation Oversight Examiner is responsible for providing support for Claims Operations as it pertains to compliance and delegation oversight function. The Claims Delegation Oversight Examiner will assist with health plan and regulatory audits pertaining to claims adjudication, ensuring claims are processed accurately, timely and in compliance with company policies, legal regulations and contractual agreements.Duties And Responsibilities Review the deficiencies in a health plan/regulatory audit for discrepancies, errors or inefficiencies. Communicate findings related to claims errors, root causes and needed changes to Claims Leadership. Work with teams to ensure that claims are compliant with standards and regulations. Adhere to deadlines request. Analyze claims and troubleshoot to identify potential issues and improve the accuracy and overall quality. Participate in health plan audits and trainings. Communicate with Claims Leadership and external organizations. Adhere to organizational policies and procedures/regulations. Minimum Job Requirements 3 years of Claims Examiner/Auditor experience Strong organizational and mathematical skills The ability to work independently and adhere to deadlines. Proficient in all tools used by the Claims Dept. Skill And Abilities Experience in managed care or health plan delegation oversight preferred. Excel and analytic experience. Must be detailed oriented, able to work independently, and multitask