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Chartered Accountant
Evolent Health Hiring for Supervisor, Audit Job at Pune Full Time
It’s Time For A Change…
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign’s Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by Parity.org; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Position summary
Evolent is looking for bright and energetic individuals to be a Supervisor for Claim Auditor & Quality Assurance.
Essential functions
Effectively handle multiple initiatives as the same time.
Effectively communicate across all levels of management and management personnel.
Ensure compliance with contract administration, demographic maintenance, and service level requirements through claim reviews and client appeals.
Conducts Audit-the-Auditor claim audits.
Support recoupment and recovery activities for claim overpayments.
Support request for funding and other financial related activities supporting claims adjudication.
Support business goals & system fixes by claim reviews, analyzing, identifying, and resolving issues.
Participate in documenting and prioritizing potential solutions to issues & fallout for system issues.
Establish and implement interim workaround solutions as needed and communicates to all impacted users.
Assist in establishing and communicating new and existing policy and procedures.
Facilitate discussions and solutions with matrix partners and acts as a subject matter expert.
Accountable for analyzing and measuring results of implemented policies, changes and system modifications.
Effectively handle multiple initiatives as the same time.
Effectively communicate across all levels of management and management personnel
Other duties as assigned
Key competencies/skill/success factors:
In-depth knowledge of Claims and claims adjudication.
Strong people management skills.
Ability to ensure strong Client Relationship.
Decision making abilities.
Strong Reporting Skills.
Knowledge of health insurance, HMO and managed care principles.
Critical thinking skills to build efficiencies
Create and manage productivity reports
Create and maintain policy and procedures
Manage and execute projects
Excellent interpersonal, oral and written communication skills
Strong attention to detail and organization
Able to work independently; strong analytic skills
Strong computer skill
Qualification and Experience:
Required
Associate or Bachelor degree preferred.
Extensive experience in health insurance claims processing with a minimum of 6 to 8 years
HMO Claims or managed care environment preferred
Big plus
Proficiency in MS Office and knowledge in macro is additional advantage
Physical demand:
Include the physical demands of the job, including bending, sitting, lifting and driving. For example, while performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
Why Join Evolent?
Named among Forbes’ 2014 America’s Most Promising Companies and Glassdoor’s 2015 Best Places to Work, Evolent provides an opportunity to work with top talent in an organization committed to career development. While we come from a variety of backgrounds, we pursue a singular mission: to change the health of the nation by changing the way health care is delivered