Elevance Health

Elevance Health

Claims Auditor Lead

GA-ATLANTA, 740 W PEACHTREE ST NW, USA

Sponsorship not specifiedDetected 8 hours ago
AccessibilityAuditingInventory ManagementHRISCollaborationAdaptabilityMicrosoft OfficeInternal Audit

About the role

  • This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.
  • Alternate locations may be considered if candidates reside within a commuting distance from an office.
  • Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy.

Responsibilities

  • Claims Auditor Lead
  • CLM > Claims Support
  • They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

Requirements

  • If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation.

Nice to have

  • BA/BS degree is preferred
  • Stop loss insurance experience is preferred
  • Proficiency in Microsoft Office Suite is highly preferred.
  • Preferred Requirements:

Skills

  • Utilizes inventory management strategies to monitor priorities and ensure timely turnaround of all claims.
  • Responsible for creating, updating and maintaining departmental policy and claims auditor procedure manuals for accuracy.
  • Independently analyzes and makes decisions on complex claim audit issues.
  • Serves as subject matter expert on policy, workflow and technical questions.
  • Responsible for reviewing and resolving shared mailbox issues.
  • Interprets contracts, prepares monthly reports, and attends meetings as subject matter expert when requested.
  • Reviews and responds to external audit requests.

Compensation

  • Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health.

Benefits

  • Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health.
  • Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
  • Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler.
  • At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.
  • The health of our associates and communities is a top priority for Elevance Health.
  • Elevance Health will also follow all relevant federal, state and local laws.
  • Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
  • Elevance Health operates in a Hybrid Workforce Strategy.
  • Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.

Company info

  • Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
  • How We Work
  • At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
  • We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
  • We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
  • Our values and behaviors are the root of our culture.
  • Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
  • We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza.

Equal opportunity

  • Applicants who require accommodation to participate in the job
  • application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Visa & Work Authorization

  • ent Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gend
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This listing is sourced directly from Elevance Health's careers page and normalized into a canonical job model.