Claims Auditor

As a Lead Auditor you will apply your audit, project management and client management skills to lead client audits. You will serve as the team leader and primary interface with administrators. You will review discrepancy issues identified by field auditors, re-adjudicate claims, resolve open issues, and draft the final report. You will contribute to the creation of new tools and approaches.

The Responsibilities

• Conduct pre-implementation and coverage specific audits and accurately document and record all audit findings
• Understand client’s plans and apprise team of unique provisions/issues prior to audit
• Adjust workloads as necessary to achieve successful completion of project
• Clearly communicate and professionally interact with vendor and audit team
• Review documentation of potential discrepancies for thoroughness and accuracy
• Resolve post-audit activities in an accurate and timely fashion
• Write quality value-added draft report in a timely manner
• Participate in client presentation of findings, when requested
• Understand vendors’ processes, operating environment, and specific challenges and take them into account with daily work
• Develop working relationship with vendor counterparts
• Distribute individual claim/work queues to team in a timely manner
• Efficiently utilize audit-specific analytic techniques, tools and processes
• Ensure that Professional Excellence protocols are followed
• Meet billable hours target
• Seek opportunities to improve work processes and methods in pursuit of quality output and service delivery
• Role will be working remotely within the posted locations.

Qualifications 

• 5+ years’ experience in health claims adjudication gained preferably in a consulting environment and/or in a major insurance claims administrator or health plan environment
• Solid understanding of health and welfare plan design and all areas of claims administration, as well as of vendors’ processes and operating environment
• Familiarity with all plan types including consumer-driven, PPO, Indemnity and Managed Care
• Must demonstrate a high level of claims administration knowledge, including experience with medical, dental, mental health and Medicare
• Detailed knowledge of ICD-10 and CPT codes and coding protocols
• Excellent oral and written communications skills
• Team player with strong work ethic
• Self-directed; requiring very little supervision
• Previous internal audit experience at a carrier or third-party external audit experience a plus

Compensation and Benefits 

Base salary range and benefits information for this position are being included in accordance with requirements of various state/local pay transparency legislation. Please note that salaries may vary for different individuals in the same role based on several factors, including but not limited to location of the role, individual competencies, education/professional certifications, qualifications/experience, performance in the role and potential for revenue generation (Producer roles only).

Compensation 

The base salary compensation range being offered for this role is $80,000 – $90,000 USD.

This role is also eligible for an annual short-term incentive bonus

Company Benefits

WTW provides a competitive benefit package which includes the following (eligibility requirements apply):

• Health and Welfare Benefits: Medical (including prescription coverage), Dental, Vision, Health Savings Account, Commuter Account, Health Care and Dependent Care Flexible Spending Accounts, Group Accident, Group Critical Illness, Life Insurance, AD&D, Group Legal, Identify Theft Protection, Wellbeing Program and Work/Life Resources (including Employee Assistance Program)
• Leave Benefits: Paid Holidays, Annual Paid Time Off (includes state/local paid leave where required), Short-Term Disability, Long-Term Disability, Other Leaves (e.g., Bereavement, FMLA, ADA, Jury Duty, Military Leave, and Parental and Adoption Leave), Paid Time Off (only included for Washington roles)
• Retirement Benefits: Qualified contributory pension plan (if eligible) and 401(k) plan with annual nonelective company contribution. Non-qualified retirement plans available to senior level colleagues who satisfy the plans’ eligibility requirements.

Pursuant to the San Francisco Fair Chance Ordinance and Los Angeles County Fair Chance Ordinance for Employers, we will consider for employment qualified applicants with arrest and conviction records.

At WTW, we trust you to know your work and the people, tools and environment you need to be successful. The majority of our colleagues work in a ”hybrid” style, with a mix of remote, in-person and in-office interactions dependent on the needs of the team, role and clients. Our flexibility is rooted in trust and “hybrid” is not a one-size-fits-all solution.

We understand flexibility is key to supporting an inclusive and diverse workforce and so we encourage requests for all types of flexible working as well as location-based arrangements. Please speak to your recruiter to discuss more.

This position will remain posted for a minimum of three business days from the date posted or until sufficient/appropriate candidate slate has been identified. 

Note: Employment-based non-immigrant visa sponsorship and/or assistance is not offered for this specific job opportunity

EOE, including disability/vets