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Claims Audit Specialist
A company is looking for a Specialist, Config Oversight. Key Responsibilities Conducts audits on vendor and focal processes to ensure accuracy and adherence to business requirements Reviews and evaluates updates to member enrollment, provider contracts, and claim processing guidelines Documents audit results and presents findings with recommendations for improvements Required Qualifications Associate's Degree or equivalent combination of education and experience Minimum 2 years of experience as an operational auditor in core operations Previous examiner or processing experience in a core operations functional area Experience using claims processing systems, specifically QNXT Knowledge of Microsoft applications including Excel, Word, Outlook, PowerPoint, and Teams
A company is looking for a Specialist, Config Oversight.
Key Responsibilities
Conducts audits on vendor and focal processes to ensure accuracy and adherence to business requirements
Reviews and evaluates updates to member enrollment, provider contracts, and claim processing guidelines
Documents audit results and presents findings with recommendations for improvements
Required Qualifications
Associate's Degree or equivalent combination of education and experience
Minimum 2 years of experience as an operational auditor in core operations
Previous examiner or processing experience in a core operations functional area
Experience using claims processing systems, specifically QNXT
Knowledge of Microsoft applications including Excel, Word, Outlook, PowerPoint, and Teams