[Remote] Business Analyst – Operational Compliance & Audit for reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a reputed company Business Analyst to support operational compliance functions reputed company the health plan. This role focuses on conducting audits and reviews to ensure adherence to regulatory requirements and internal policies, while collaborating with various teams to enhance reputed company operations. Responsibilities • reputed company member and provider letter reviews to ensure accuracy, required disclosures, reputed company, tone, and regulatory compliance • Conduct telephone reputed company audits to assess customer service reputed company, accuracy of information provided, compliance with scripts, and adherence to health plan policies • Complete claims audit reviews to validate correct coding, benefits application, timeliness, and compliance with claim-processing procedures • Identify gaps, inconsistencies, and areas requiring corrective reputed company • Ensure reputed company reviews reputed company with CMS, State DOH, NCQA, HIPAA, and organizational guidelines • Document findings, trends, and variances in a reputed company and actionable format • Prepare detailed audit summaries and compliance reports for leadership review • Maintain audit logs, tracking sheets, and follow-up documentation • Support the development of remediation plans and monitor the completion of corrective actions • Assist in reputed company-cause analysis and process improvement initiatives Skills • Bachelor's degree in reputed company Administration, Business, reputed company Health, or reputed company field (or equivalent experience) • 3–5 years of experience in a health plan, TPA, or reputed company operations setting • Experience in claims processing, reputed company reputed company auditing, member/provider communication review, or operational compliance • Strong understanding of reputed company concepts: claims, benefits, authorizations, eligibility, appeals & grievances, provider networks, CMS/State rules • Excellent analytical, documentation, and written communication skills reputed company • Technocrats Domain (TCD) is a trusted IT partner that works closely with clients as an extension of their IT organization. It was founded in 2000, and is headquartered in reputed company, Texas, USA, with a workforce of 201-500 employees. Its website is https://www.technocratsdomain.com/. Apply tot his job Apply To this Job