Clinical Provider Auditor II responsible for examining claims and identifying fraud risks at Elevance Health. Collaborating with internal teams and assisting in training new associates.
About the role
- Field Premium Auditor conducting remote or on-site audits for Encova Insurance to ensure proper reporting and payment of premiums. Requires a bachelor's degree and relevant experience.
Responsibilities
- Conduct audits primarily remote or as needed on-site examination of an employer’s accounting records to verify and record classification information and to ensure premium payments are correct and in compliance with applicable law.
- Prepare audit worksheets to support audit adjustments and recommendations, and document audit trail.
- Develop and determines premium basis, earned premium, and classification in accordance with company, industry and government rules and regulations.
- Effectively communicate audit results to internal and external customers regarding classification/payroll variances.
- Ensure quality of audit through proper risk classification and exposure basis identification.
- Maintain knowledge of current trends and developments in the field.
- Use PowerSuite, Guidewire and related internal systems as required to perform duties.
Requirements
- Bachelor’s degree from an accredited college or university required (Accounting emphasis is preferred); commensurate accounting, auditing, or commercial insurance experience may be substituted for degree.
- Insurance experience strongly preferred.
- Ability to analyze and interpret accounting records.
- Proficient in use of spreadsheets to include but not limited to Excel.
- Ability to navigate and effectively use accounting, auditing or insurance systems.
- Ability to advise policyholders on how to provide proper records necessary to conduct audits using NCCI, ISO, and PCRB classifications and rules.
- Ability to establish and maintain effective working relationships.
- Strong customer service orientation.
- Strong oral and written communication skills.
- Ability to effectively organize, prioritize and complete assigned work.
- Ability to work independently.
- Ability to actively listen to internal and external customer requests and concerns and develop appropriate solutions.
- Ability to identify customer needs and take appropriate action to meet those needs.
- Ability to safely operate a motor vehicle.
- Must hold a valid driver’s license.
Benefits
- Health, Dental & Vision Insurance
- Company-provided life and income protection plans
- Eligibility to participate in a company incentive bonus program
- 401(k) Retirement Plan - 100% company match up to 7% on annual salary
- Paid Time Off, Paid Holidays, and Floating Holidays
- Flexible Work Arrangements - Hybrid and remote depending on the role
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