Directs the Claims Quality Audit Department and provides managerial oversight to employees engaged in claims auditing and training. Approves department policies, practices, and procedures to ensure identification of claims processing errors. Provides planning, organizing, and budgeting for the department. Typically... [+] More

Directs the Claims Quality Audit Department and provides managerial oversight to employees engaged in claims auditing and training. Approves department policies, practices, and procedures to ensure identification of claims processing errors. Provides planning, organizing, and budgeting for the department. Typically requires a college degree in a related field and an in-depth understanding of claims auditing.

Provides oversight of departmental training and auditing activities. Monitors departmental operations to ensure compliance with regulatory agencies and contractual obligations. Develops strategic initiatives and transforms initiatives into action plans. Hires, trains, and motivates a qualified management staff. Oversees the development of training programs that are targeted toward error reduction and decision quality in claims processing. Analyzes audit and training reports to determine department effectiveness. [-] Less

Develops, directs, and administers the organization's internal audit and compliance functions in accordance with the audit plan and audit schedule to mitigate loss and risks. Monitors organization operations and each financial system and evaluates their efficiency, effectiveness of controls, accuracy... [+] More

Develops, directs, and administers the organization's internal audit and compliance functions in accordance with the audit plan and audit schedule to mitigate loss and risks. Monitors organization operations and each financial system and evaluates their efficiency, effectiveness of controls, accuracy of records, and compliance with internal corporate policies and procedures and external laws and government regulations.

Measures and evaluates the effectiveness and efficiency of business practices and operations, the reliability of financial reporting, the process for deterring and investigating fraud, and the safeguarding of company assets. Examines and evaluates the organization's financial and information systems, management procedures, and managerial and internal controls to ensure records and controls are accurate. Analyzes and recommends business improvements and ways to better execute the organization's responsibilities. Recommends controls for organization's computer system to ensure reliability of the system and integrity of the data. Provides counsel and advice to management regarding implications of audit and compliance findings, and recommends appropriate corrective measures. [-] Less

Directs and oversees the function or department that audits examination and analysis of electronic data processing (EDP) records of an organization, reviews reports concerning documentation and operating procedures, and oversees the process of the reviewing of data regarding material assets,... [+] More

Directs and oversees the function or department that audits examination and analysis of electronic data processing (EDP) records of an organization, reviews reports concerning documentation and operating procedures, and oversees the process of the reviewing of data regarding material assets, net worth, liabilities, capital stock, surplus, income, and expenditures. Examines recording transactions in original entries to confirm that proper procedures were followed. Reviews department systems and activities, and evaluates current procedures and practices for accomplishing department objectives.

Monitors and analyzes department budget to identify budget needs and/or reductions and allocates department budget funds. [-] Less

Directs the Internal Audit Department and provides managerial oversight for reviewing and appraising the soundness, adequacy, compliance, and cost effectiveness of operational and financial controls and audits. Establishes and implements work standards and procedures for the inspection and appraisal of... [+] More

Directs the Internal Audit Department and provides managerial oversight for reviewing and appraising the soundness, adequacy, compliance, and cost effectiveness of operational and financial controls and audits. Establishes and implements work standards and procedures for the inspection and appraisal of financial and operational records and controls. Typically requires a minimum of a college degree in a related field and an in-depth understanding of internal audit. Frequently requires an advanced degree.

Provides planning, organizing, and budgeting for the department. Performs risk analyses and evaluation of controls, including assessing the impact of control deficiencies. Provides oversight of departmental training and auditing activities. Prepares audit reports and makes recommendations to improve internal controls, business processes, and financial accounting. Monitors departmental operations to ensure compliance with regulatory agencies. Develops strategic initiatives and transforms initiatives into action plans. Hires, trains, and motivates a qualified management staff. Participates in sensitive or complex audit engagements. May participate in financial due diligence for potential acquisitions. May work with and coordinate an external audit organization to perform substantive year-end audit. [-] Less

Directs and oversees the function or department that audits examination and analysis of electronic data processing (EDP) records of an organization, reviews reports concerning documentation and operating procedures, and oversees the process of the reviewing of data regarding material assets,... [+] More

Directs and oversees the function or department that audits examination and analysis of electronic data processing (EDP) records of an organization, reviews reports concerning documentation and operating procedures, and oversees the process of the reviewing of data regarding material assets, net worth, liabilities, capital stock, surplus, income, and expenditures. Examines recording transactions in original entries to confirm that proper procedures were followed. Reviews department systems and activities, and evaluates current procedures and practices for accomplishing department objectives.

Monitors and analyzes department budget to identify budget needs and/or reductions and allocates department budget funds. [-] Less

Supervises and facilitates the coordination and scheduling of all external claims audits conducted by customers, audit firms, external vendors, and regulators. Assists in the preparation of audits and management of the audit process.

Notifies appropriate parties of the audit and schedules... [+] More

Supervises and facilitates the coordination and scheduling of all external claims audits conducted by customers, audit firms, external vendors, and regulators. Assists in the preparation of audits and management of the audit process.

Notifies appropriate parties of the audit and schedules entrance and exit conferences. Develops tools to assist staff in effectively coordinating audits and holds staff meetings as needed. Reviews customer contracts for audit rights, and prepares necessary audit confidentiality agreements and Par Plan addendum agreements. Supervises the obtaining and reviewing of claim samples and documentation. Ensure all HIPAA requirements applicable to the job are met. Directs and oversees analysis of requested data in order to minimize organization's risks. Ensures data integrity. Assures that auditors have a positive experience. Reviews findings and responses for adequacy and appropriateness. Reviews draft and final audit reports from auditors. Prepares responses to report findings. May travel to other claims audit locations as needed. [-] Less

Manages the auditing... [+] More

Manages the auditing examination and analysis of electronic data processing (EDP) records of an establishment, and devises reports concerning documentation and operating procedures. Oversees operation of reviewing data regarding material assets, net worth, liabilities, capital stock, surplus, income, and expenditures. Develops audit programs and reviews systems operations, controls, and security guidelines.

Inspects items in books of original entry to determine if proper procedure in recording transactions was followed. Reviews systems and those who have access to computerized records. Provides advice to others regarding security procedures and internal controls. Prepares EDP audit function activity reports for upper management. [-] Less

Manages and... [+] More

Manages and coordinates activities of auditors conducting independent protective and constructive audits for management to review effectiveness of controls, financial records, and operations. Contributes to the design and implementation of company audit procedures. Establishes systems and standards for conducting audits. Reviews records of functions audited to ensure proper recording of transactions and compliance with applicable laws.

Inspects accounting systems to determine their accuracy, efficiency, and protective value. Reviews records pertaining to material assets, such as equipment, buildings, or manpower to determine degree to which they are utilized. Analyzes data obtained for evidence of deficiencies in controls, duplication of effort, extravagance, fraud, or lack of compliance with management's established policies or procedures. Develops audit programs for specific audits. Conducts special studies for management. Prepares reports of findings and makes recommendations to upper management. [-] Less

Manages the auditing... [+] More

Manages the auditing examination and analysis of electronic data processing (EDP) records of an establishment, and devises reports concerning documentation and operating procedures. Oversees operation of reviewing data regarding material assets, net worth, liabilities, capital stock, surplus, income, and expenditures. Develops audit programs and reviews systems operations, controls, and security guidelines.

Inspects items in books of original entry to determine if proper procedure in recording transactions was followed. Reviews systems and those who have access to computerized records. Provides advice to others regarding security procedures and internal controls. Prepares EDP audit function activity reports for upper management. [-] Less

Supervises employees engaged in claims auditing and training. Implements claim auditing department policies, practices, and procedures to ensure identification of claims processing errors. Typically requires prior experience as a Claims Processor or Adjudicator and an in-depth understanding of claims auditing.

Supervises... [+] More

Supervises employees engaged in claims auditing and training. Implements claim auditing department policies, practices, and procedures to ensure identification of claims processing errors. Typically requires prior experience as a Claims Processor or Adjudicator and an in-depth understanding of claims auditing.

Supervises auditing activities by monitoring weekly backlogs, distributing audit assignments based on work loads, and reviewing and responding to audit inquiries. Responds to error rebuttals from Claims Processors or Adjudicators. Assists in hiring, training, coaching, and evaluating performance of assigned staff. Contributes to the development of training programs that are targeted toward error reduction and decision quality in claims processing. Monitors training programs to evaluate effectiveness. [-] Less