Claims Audit Specialist_Quality Assurance
: Job Details :

.Claims Audit Specialist Claims Audit Specialist Who are we? Versant Health is one of the nation's leading administrators of managed vision care, serving millions of our clients' members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and vision. As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us. See how you can make a difference with the support of strong leadership and a team environment. See Everything, Be Anything. What are we looking for? The Claims Audit Specialist will lead quality reviews of work performed within Operations in accordance with the Departments guidelines. Analyze findings, report results and make suggestions on process improvements where common errors have been identified. Engage in the department or corporate projects in a continuous improvement environment to continually ensure that the work performed in these functional areas is accurate, complete, and improved. Where you will have an impact Responsible for conducting a quality review of functions performed Recommend corrections/changes to the systems, policies, and procedures, to ensure a higher quality of work performed Provide feedback to associates and management to improve how individuals and departments can improve workflow to eliminate repeated errors Assist the department Manager with conducting a routine review of the quality program to ensure it constantly meets business and regulatory requirements Provide regular feedback and recommendations to department Manager regarding staff performance and improvement Responsible for conducting quality reviews and maintaining documentation as mandated by control activity for SSAE 16 and Financial audits Assist in department/corporate projects, as assigned by department Manager/Director, in an effort to ensure that system upgrades, changes in policies, procedures or benefits are introduced into the department accurately and timely Other duties as assigned What's necessary to do the job? Preferred Bachelor's degree in related field or equivalent combination of experience and education One (1) year of related experience: Quality Review, Quality Assurance, or Process Improvement preferred Three (3) years of related experience in Claims required Bilingual skills a plus Proficiency in Microsoft Office HIPAA & Security Requirements All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company's Privacy & Security Training Program. Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process. Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law. The wage range for applicants for this position is [$22.50 to $23.50]. All incentives and benefits are subject to the applicable plan terms.