Claims Audit Manager
Collective Health is transforming the way people experience health care. To accomplish this, we are building a world-class team to bring clients onboard our innovative technology platform.
We are looking for a Claims Audit Manager to spearhead our internal audit capabilities, driving operational standards for new and existing client plans. This person will perform comprehensive claims audits, in addition to working cross-functionally across our Operations teams to identify workflow oversights and create preventive measures to improve claims accuracy. Our team has a high bar for attention to detail and quality output, and we’re looking for a leader who can both push and support our team members in their work. At Collective Health, you will use your expertise in health plan and claims operations to build and scale our quality processes, while being at the forefront of transforming the industry.
What you’ll work on:
- Perform and advise on internal comprehensive claim audits to identify procedural and financial adjudication errors – apply statistical techniques and software tools to guarantee representative sample sizing and stratification
- Scope and build out internal pre- and post-pay auditing function – leverage industry experience to develop a creative and scaleable audit program that aligns with industry standards and Collective Health’s growing claims volume
- Lead and support Plan Operations team during claims process and accuracy reviews by external audit partners
- Work cross-functionally across Plan Operations to surface claims workflow gaps and implement corrective action plans
- Collaborate with Operations, Legal, and Client Success teams to draft and measure client performance guarantees as they relate to claims quality
Our ideal person:
- Has 5 - 10 years experience in health plan operations, claims processing and/or auditing experience strongly preferred
- Displays extreme attention to detail while working in fast-paced, high-energy environments
- Thrives on finding solutions while navigating difficult and ambiguous situations
- Shares our passion for reshaping the healthcare industry
- Fast learner – you will need to become proficient with a large volume of information over a short timeline
- Although our claims team is located in our home office, we will also consider remote candidates with occasional travel to San Francisco.
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
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Senior Software Engineer
After a member visits their doctor or fills a prescription, Collective Health ensures members are billed accurately and providers are paid. Erica leads the development of the interface that enables the Operations Team to quickly and accurately process claims—ensuring money flows to the right people.
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