Company Description
At Convey Health Solutions, we focus on building specific technologies and services that can uniquely meet the needs of government sponsored health plans. We provide member management solutions for the rapidly changing healthcare world.
Job Description
The Auditor (Benefit Administration Program) is responsible for performing internal audits and monitoring activities related to the Over the Counter (OTC) supplemental benefit under Medicare Advantage and Medicaid Plans
The Auditor is also responsible for reporting audit results to management/operational designers and assisting with the development of remediation plans as necessary
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Perform internal audits and monitoring activities to ensure compliance with company policies, client contracts, and regulatory guidelines
- Report results of auditing and monitoring activities and assist with the development of remediation plans as necessary
- Track the progress of remediation plans
- Provide assistance with external client audits requests
- Provide assistance with OTC catalog and product formulary reviews and maintenance
- Research and respond to complaints and grievances
- Participate in ongoing education and training
Qualifications
- Bachelor’s degree (B.A.) from a four-year college or university preferred; or one to two years related experience and/or training or equivalent combination of education and experience
- Knowledge of Medicare regulations and processes preferred
- Ability to lead and to work independently, a self-starter, creative thinker with high professional standards and integrity.
Ability to thrive in a very busy and complex work environment with changing priorities.
Additional Information
All your information will be kept confidential according to EEO guidelines.