Alignment Health

Auditor, Delegate Claims

AuditorAuditorFull TimeRemoteSeniorTeam 501-1,000Since 2013H1B No SponsorCompany Site LinkedIn

Location

United States

Posted

34 days ago

Salary

$70.8K - $106.2K / year

Seniority

Senior

High School3 yrs expEnglish

Job Description

• Conduct audits in accordance with regulatory, contractual, and industry standards • Execute detailed claims audits using established methodologies, sampling frameworks, and documentation standards to ensure accuracy, consistency, and regulatory readiness • Communicate audit scope, expectations, and timelines clearly to delegated provider organizations throughout the audit lifecycle • Review and validate Corrective Action Plans (CAPs) submitted by delegated entities to ensure remediation fully addresses identified deficiencies

Job Requirements

3-5 years of claims experience in an HMO, Medicare Advantage, and/or IPA setting
1-2 years minimum experience conducting oversight audits of delegated entities and/or ancillary providers
Strong knowledge of Medicare audit processes and applicable state and federal regulatory requirements governing delegated claims operations
High attention to detail with strong analytical and problem-solving capabilities to evaluate data, identify patterns, and determine root causes of issues.
Advanced proficiency with Microsoft Office applications, especially Excel, Word, PowerPoint, and Outlook

Benefits

Health insurance
Retirement plans
Paid time off
Flexible work arrangements
Professional development

Related Categories

Auditor

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