Senior Internal Auditor at Daikin Europe managing operational audit engagements across EMEA. Focusing on risk assessment, compliance, and analytical improvements while supporting team development.
About the role
- Provider Auditor Senior at Elevance Health conducting audits on medical claims and ensuring compliance with contracts. Analyzing data and mentoring staff while working in a hybrid environment.
Responsibilities
- conducts on-site reviews of medical charts, medical notes, itemized bills and provider contracts
- selects providers to be reviewed based on historical results of other reviews with providers
- schedules review with provider
- analyzes data to select claims to be reviewed
- conducts review using medical charts, medical notes, itemized bills and provider contracts
- conducts exit interview with provider management team by presenting preliminary review results
- verifies dollar amount on claim is correct in claims system
- writes report of the findings of the review
- requests payments for any overpayments
- identifies aberrant patterns of billing and detects potential abuse
- mentors and trains Provider Auditor as needed
- drafts department policies and procedures and other educational materials
- works on task forces and committees representing functional area
Requirements
- Requires a BA/BS degree
- a minimum of 3 years equivalent work experience
- Certification as a Professional Coder preferred
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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