Claims Audit Specialist_Quality Assurance

Claims Audit Specialist
Claims Audit Specialist

Who are we? Versant Health is one of the nation's leading administrators of managed vision care, serving over 35 million of our clients' members across the United States. Our purpose is to make healthy vision a reality for everyone by improving access to care and education in the communities we serve. Fueled by our mission to improve members' lives with easy-to-use vision solutions rooted in choice value, and care, we believe that everyone has the power to become anything they set their sights on.

See how you can make a difference with the support of strong leadership and a team environment.

Versant Health : Making Healthy Vision a Reality for Everyone

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.

We provide equal employment opportunities (EEO) to all associates and applicants for employment without regard to race, color, religious beliefs, sex, gender identity, sexual orientation, age, marital status, national origin, ancestry, physical or mental disability or history of disability, genetic information, status as a protected veteran or disabled veteran, or any other status protected by Federal, state or local law. We offer a comprehensive and competitive total rewards package designed to support your health, financial well being, and work life balance. Benefits include medical, dental, and paid vision coverage; paid time off and company holidays; retirement savings with employer contribution; employee wellness resources; and professional development