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Auditor, Delegate Claims

AuditorAuditorOtherRemoteSeniorTeam 501-1,000Since 2013H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

108 days ago

Salary

$70.8K - $106.2K / year

Seniority

Senior

High School3 yrs expEnglish

Job Description

Auditor, Delegate Claims

Alignment Health

• Conduct audits in accordance with regulatory, contractual, and industry standards • Execute detailed claims audits using established methodologies, sampling frameworks, and documentation standards to ensure accuracy, consistency, and regulatory readiness • Communicate audit scope, expectations, and timelines clearly to delegated provider organizations throughout the audit lifecycle • Review and validate Corrective Action Plans (CAPs) submitted by delegated entities to ensure remediation fully addresses identified deficiencies

Job Requirements

  • 3-5 years of claims experience in an HMO, Medicare Advantage, and/or IPA setting
  • 1-2 years minimum experience conducting oversight audits of delegated entities and/or ancillary providers
  • Strong knowledge of Medicare audit processes and applicable state and federal regulatory requirements governing delegated claims operations
  • High attention to detail with strong analytical and problem-solving capabilities to evaluate data, identify patterns, and determine root causes of issues.
  • Advanced proficiency with Microsoft Office applications, especially Excel, Word, PowerPoint, and Outlook

Benefits

  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements
  • Professional development

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