Lead 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

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

Compensation

The base salary compensation range being offered for this role is $85,000- $90,000 USD per year. 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 paid 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

• Retirement Benefits:

  Contributory Pension Plan and Savings Plan (401k)

EOE, including disability/vets