Benefit and Performance Auditor

• Objectively and effectively manage and control the execution of activities and tasks associated with each audit and review project, according to developed audit procedures, and developing and presenting oral and written statements of conditions, findings and recommendations which are associated with each project
• Proactive in keeping current with corporate and subsidiary business goals and objectives, operations, and procedures; Auditing standards and practices; Business transaction processing technology; And management's internal control goals and objectives
• Perform audits and reviews with policies and objectives as requested by the manager.
• The auditor must apply constructive and imaginative thought while analyzing audit results and proposed solutions to a broad range of internal control, and benefit and performance issues; Through this analysis the auditor can determine why, when and to what magnitude an error has occurred in the process
• Responsible for preparing accurate and descriptive audit work papers and reports through audit testing, document review and research; Communicates results of audit with recommended solutions via written and oral reports to auditees and departmental management
• Contract-based auditing to include manual claim pricing and transaction review

Requirements:

• High School diploma or equivalent required; College degree or equivalent experience in health insurance industry preferred
• Five+ years of operational experience required within customer service, claims, or membership
• FEP/MTM customer service experience preferred
• Analytical thinker with strong conceptual and problem-solving skills
• Meticulous attention to detail with the ability to organize priorities
• Ability to work independently and as part of a team
• Excellent documentation, communication and time management skills
• Ability to obtain information from others and professionally deliver information both orally or in written form
• Knowledge of regulatory audit programs, standards and guidelines
• Excellent understanding of health care operations with substantial systems knowledge or demonstrate the ability to learn new systems