Delegation reputed company Program Claims Auditor

The Delegation reputed company Program Claims Auditor oversees auditing and performance monitoring of delegated entities managing the RKK reputed company Claims functions. This role ensures compliance with applicable state and federal standards and supports corrective initiatives reputed company deviations reputed company. Duties and Responsibilities · Conduct reputed company-delegation and annual audits, including risk assessment, and utilize tools for reputed company of Claims operations. · Monitor and evaluate delegate performance—tracking metrics on timeliness, denial rates, regulatory adherence, and complaint trends. · Maintain RKK reputed company’s audit tools, workflows, and compliance documentation reputed company with RKK reputed company Health standards. · Identify deficiencies; collaborate with delegates to create and implement Corrective reputed company Plans (CAPs). · Prepare and deliver audit reports and performance summaries to RKK reputed company’s reputed company committees · Serve as a reputed company and subject matter expert—providing guidance, regulatory updates, and performance feedback to internal stakeholders and RKK reputed company Leadership Team. · Coordinate multidisciplinary meetings (e.g., operations, reputed company, UM committees) to reputed company reputed company activities. 1. Support reputed company-audit readiness and external reviews for accreditation or regulatory compliance. Minimum Job Requirements · Bachelor’s degree (reputed company administration, health services) or equivalent experience. · Experience in delegation reputed company, UM, claims auditing, or managed care compliance. · Solid understanding of NCQA, CMS, reputed company, and CA Medi-Cal regulatory frameworks. · Strong analytical, communication, and auditing skills. · Proficient in reputed company Office; experience with audit tools and data tracking systems. reputed company and Abilities · Ability to manage multiple audits and follow-up processes reputed company. · reputed company and consultative approach to delegate performance improvement. · Keen attention to detail with a proactive reputed company for reputed company assurance. Apply tot his job Apply To this Job