Lead Analyst, Claims COB Audit

JOB DESCRIPTION Job Summary Provides lead level support for COB-specific claim pricing audits. Responsible for accurate and timely implementation and maintenance of critical information on claims/provider databases, validating data housed on databases and ensuring adherence to business and system requirements. Facilitates end-to-end claim audits, maintains audit records, provides counsel regarding coverage amount/benefit interpretation within the audit process, monitors and controls backlog and workflow of audits, and ensures that audits are completed in a timely fashion and in accordance with audit standards. Essential Job Duties - Accurately interprets end-to-end business requirements, and confirms that outcomes meet specific state/federal requirements. - Creates reporting tools to enhance audit communications on configuration accuracy results and/or audit findings - Writes complex ad-hoc reports related to configuration/claims. - Interprets and validates accuracy of compl...