GHRS Health Claims Audit, Proj. Mgr.

Job Description -- PricewaterhouseCoopers Human Resource Services (HRS) practice is one of the world?s largest HR, actuarial, and tax planning businesses, with approximately 6,000 professionals worldwide. We bring together all our local and global professionals working in the Human Resource Services arena actuaries, accountants, attorneys, tax specialists, communications experts, personal financial advisors, as well as HR professionals, with expertise in the area of benefits, assessment, compensation, staffing and process management affording our clients an unmatched breadth and depth of expertise.

PricewaterhouseCoopers is seeking an experienced manager to manage the overall VEBA claims testing process performed by the healthcare Vendor Performance Group (VPG). The VPG performs testing of medical and dental claims for 175 audit clients/ 300 benefit plans to provide assurance of accuracy of the claims paid and reported on the client?s financial statements. The focus of this position is to work with the financial auditors to balance the completion of the claims testing for all clients by the filing date with utilization of available VPG resources. Primary responsibilities include working with the financial audit contacts / managers and partners on readiness activities and overseeing a group of data specialists, scheduling staff, field claims auditors and other staff to complete the testing and follow-up activities throughout the year. This position is based in Chicago.


Years of Experience Required
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5-7

Education Required
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- Minimum: Bachelor?s degree, some post-graduate work is desired
- Seasoned management skills for dealing with people and scheduling issues (5 - 7 years of experience preferred)
- Exceptional phone skills
- Ability to juggle multiple tasks/clients, provide direction to data analysis, scheduling and claims audit staff and manage the overall process under pressure with continous changing priorities
- Prior knowledge of healthcare claims testing not required, but the ability to quickly learn key critical path technical components is required
- Exceptional project management skills are essential
- Must be results-driven and comfortable with empowering and enabling team to achieve success as a group
- Travel: minimal travel required

Job Requirement Essential
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- Working with audit contacts / managers to further define the required scope of testing to meet PwC policy and to outline steps of the the claims testing process
- Manage the relationship with the 6-7 major healthcare vendors where testing is required to plan for the required frequency and timing of required on-site dates.
- Directing the data reconciliation and sample selection process for each client/plan.
- Coordinating staff assignments and scheduling
- Leading meetings to discuss project status with Chicago-based staff and claims auditors
- Resolving escalated issues regarding data reconciliation, staff priorities and other problems that arise during the normal course of the testing process
- Participating on update calls with senior VEBA financial audit leadership people on testing progress
- Managing the end to end testing process for each client to maintain the weekly/monthly/annual utilization of the Chicago-based team and field auditors at 75% or greater .
- Overseeing VPG?s compliance with audit documentation requirements

Travel Required
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0-20%

Type of Position
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Full Time