Willis Towers Watson

Audit Analyst

Posted on Mar 31 158 views Tampa, FL

As an Audit Analyst you will apply your audit, project management and client management skills in leading the process during onsite audits. You will serve as the onsite 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 Role

The incumbent will also:

  • conduct pre-implementation audits and accurately document and record all audit findings.
  • Understand client’s plans and apprise team of unique provisions/issues prior to onsite audit
  • Adjust workloads as necessary to achieve successful completion of project
  • Clearly communicate and professionally interact with vendor and onsite audit team
  • Review documentation of potential discrepancies for thoroughness and accuracy
  • Resolve post-onsite 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 onsite 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

The Requirements

  • 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
  • Ability to travel 50%-70%

EOE, including disability/vets