Claims Quality Analyst [United States]

 Who are we?
Versant Health is one of the nation’s leading administrators of managed vision care, serving millions of our clients’ members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and vision.

As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us.

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What are we looking for?
This position is responsible for preparing, presenting and explaining all documentation necessary, for audits conducted in regard to claim adjudication. Audit types include regulatory (state and federal), client and third-party administrators representing clients. Responsible for being involved face to face with auditors explaining Versant Health claim processes and procedures, claim processing systems and audit materials as well as any other questions or requests presented. This incumbent represents Versant Health for all claim audits.

Where you will have an impact

• Responsible for collecting all claim materials, as required in the audit confirmation letter, with on-time delivery. This includes, but is not limited to, universe request (in requested format) and all end to end claims processing documentation.
• Review and validate, in detail, all pertinent audit documentation for accuracy, prior to the audit, and alert management and business owners to concerns or adverse findings.
• Preparation of audit documentation in an acceptable format that meets the requirements of the audit confirmation letter.
• Participate in audit interviews and be available for support. This includes conducting a brief of prepared materials, performing live overviews of processing systems, explaining Versant Health claim policies and procedures and be available for Web calls.
• If audit outcome results in negative findings, the incumbent is responsible for researching history and escalate findings to management and business owners.
• If audit outcome results in corrective action, the incumbent is responsible for assisting management in completion.
• Respond to ad hoc reporting requests based on business needs.
• Responsible for developing standardized reporting templates for reporting audit results.
• Responsible for partnering with management to improve audit processes to increase client satisfaction.
• Adhere to strict confidentiality in accordance with HIPAA requirements and proprietary company policies and procedures.

What’s necessary to do the job?

• Preferred Associate's degree in related field or equivalent combination of experience and education
• One to three (3) years of related experience

HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.

Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.

The wage for applicants for this position is [$55,120.00].
All incentives and benefits are subject to the applicable plan terms.

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