WTW is looking for a Medical Claim Lead Auditor to lead client audit engagements. In this role, you will apply your audit, project management, and client management expertise as the team leader and primary contact with administrators.
What You'll Do
- Conduct pre-implementation and coverage-specific audits, accurately documenting all findings.
- Understand client plan designs and inform the team of unique provisions prior to the audit.
- Adjust team workloads as necessary to achieve successful project completion.
- Communicate clearly and interact professionally with vendors and the audit team.
- Review documentation of potential discrepancies for thoroughness and accuracy.
- Resolve post-audit activities in an accurate and timely fashion.
- Write quality, value-added draft reports in a timely manner.
- Participate in client presentations of findings when requested.
- Understand vendors’ processes, operating environment, and specific challenges to inform daily work.
- Develop a working relationship with vendor counterparts.
- Distribute individual claim and work queues to the team in a timely manner.
- Efficiently utilize audit-specific analytic techniques, tools, and processes.
- Ensure that Professional Excellence protocols are followed.
- Meet billable hours targets.
- Seek opportunities to improve work processes and methods in pursuit of quality output and service delivery.
What We're Looking For
- 5+ years’ experience in health claims adjudication.
- Solid understanding of health and welfare plan design and all areas of claims administration.
- Solid understanding of vendors’ processes and operating environment.
- Familiarity with all plan types including consumer-driven, PPO, Indemnity, and Managed Care.
- A high level of claims administration knowledge, including experience with medical, dental, mental health, and Medicare claims.
- Detailed knowledge of ICD-10 and CPT codes and coding protocols.
- Excellent oral and written communication skills.
- A team player with a strong work ethic.
- Self-directed; requiring very little supervision.
- A High School Diploma is required.
Nice to Have
- Experience gained preferably in a consulting environment and/or in a major insurance claims administrator or health plan environment.
- Previous internal audit experience at a carrier or third-party external audit experience.
- A Bachelor's Degree is preferred.
Benefits & Compensation
- Compensation: $90,000 to $98,000 USD per year.
- Health and Welfare: Mental health/emotional wellbeing, medical, dental, vision, Health Savings Account, Commuter Accounts, Flexible Spending Accounts, company-paid life insurance, supplemental life insurance, AD&D, group accident, group critical illness, group legal, identity theft protection, wellbeing program, adoption assistance, surrogacy assistance, auto/home insurance, pet insurance, and other work/life resources.
- Leave Benefits: Paid Holidays, Annual Paid Time Off, Short-Term Disability, Long-Term Disability, Other Leaves (Bereavement, FMLA, ADA, Jury Duty, Military Leave, and Parental and Adoption Leave).
- Retirement Benefits: Contributory Pension Plan and Savings Plan (401k). All Level 38 and more senior roles may also be eligible for non-qualified Deferred Compensation and Deferred Savings Plans.
Work Mode
This is a remote position open to candidates in posted locations.
WTW is an equal opportunity employer.
