Claims Auditor

As a Lead Auditor you will apply your audit, project management and client management skills to lead client audits. You will serve as the team leader and primary interface with administrators. You will review discrepancy issues identified by field auditors, re-adjudicate claims, resolve open issues, and draft the final report. You will contribute to the creation of new tools and approaches. The ResponsibilitiesConduct pre-implementation and coverage specific audits and accurately document and record all audit findingsUnderstand client’s plans and apprise team of unique provisions/issues prior to auditAdjust workloads as necessary to achieve successful completion of projectClearly communicate and professionally interact with vendor and audit teamReview documentation of potential discrepancies for thoroughness and accuracyResolve post-audit activities in an accurate and timely fashionWrite quality value-added draft report in a timely mannerParticipate in client presentation of findings, when requestedUnderstand vendors’ processes, operating environment, and specific challenges and take them into account with daily workDevelop working relationship with vendor counterpartsDistribute individual claim/work queues to team in a timely mannerEfficiently utilize audit-specific analytic techniques, tools and processesEnsure that Professional Excellence protocols are followedMeet billable hours targetSeek opportunities to improve work processes and methods in pursuit of quality output and service deliveryRole will be working remotely within the posted locations. Qualifications 5+ years’ experience in health claims adjudication gained preferably in a consulting environment and/or in a major insurance claims administrator or health plan environmentSolid understanding of health and welfare plan design and all areas of claims administration, as well as of vendors’ processes and operating environmentFamiliarity with all plan types including consumer-driven, PPO, Indemnity and Managed CareMust demonstrate a high level of claims administration knowledge, including experience with medical, dental, mental health and MedicareDetailed knowledge of ICD-10 and CPT codes and coding protocolsExcellent oral and written communications skillsTeam player with strong work ethicSelf-directed; requiring very little supervisionPrevious internal audit experience at a carrier or third-party external audit experience a plusCompensation and BenefitsBase salary range and benefits information for this position are being included in accordance with requirements of various state/local pay transparency legislation. Please note that salaries may vary for different individuals in the same role based on several factors, including but not limited to location of the role, individual competencies, education/professional certifications, qualifications/experience, performance in the role and potential for revenue generation (Producer roles only). CompensationThe base salary compensation range being offered for this role is $80,000 – $90,000 USD. This role is also eligible for an annual short-term incentive bonusCompany BenefitsWTW provides a competitive benefit package which includes the following (eligibility requirements apply):Health and Welfare Benefits: Medical (including prescription coverage), Dental, Vision, Health Savings Account, Commuter Account, Health Care and Dependent Care Flexible Spending Accounts, Group Accident, Group Critical Illness, Life Insurance, AD&D, Group Legal, Identify Theft Protection, Wellbeing Program and Work/Life Resources (including Employee Assistance Program)Leave Benefits: Paid Holidays, Annual Paid Time Off (includes state/local paid leave where required), Short-Term Disability, Long-Term Disability, Other Leaves (e.g., Bereavement, FMLA, ADA, Jury Duty, Military Leave, and Parental and Adoption Leave), Paid Time Off (only included for Washington roles)Retirement Benefits: Qualified contributory pension plan (if eligible) and 401(k) plan with annual nonelective company contribution. Non-qualified retirement plans available to senior level colleagues who satisfy the plans’ eligibility requirements. Pursuant to the San Francisco Fair Chance Ordinance and Los Angeles County Fair Chance Ordinance for Employers, we will consider for employment qualified applicants with arrest and conviction records. At WTW, we trust you to know your work and the people, tools and environment you need to be successful. The majority of our colleagues work in a ”hybrid” style, with a mix of remote, in-person and in-office interactions dependent on the needs of the team, role and clients. Our flexibility is rooted in trust and “hybrid” is not a one-size-fits-all solution. We understand flexibility is key to supporting an inclusive and diverse workforce and so we encourage requests for all types of flexible working as well as location-based arrangements. Please speak to your recruiter to discuss more. This position will remain posted for a minimum of three business days from the date posted or until sufficient/appropriate candidate slate has been identified. Note: Employment-based non-immigrant visa sponsorship and/or assistance is not offered for this specific job opportunityEOE, including disability/vetsOriginally posted on Himalayas Apply To this Job