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Auditor, Delegate Claims
Location
United States
Posted
108 days ago
Salary
$70.8K - $106.2K / year
Seniority
Senior
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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