HM Entry Audit Consultant

Description: Associates in this role assist in the assessment of health administrators, focusing on the preparatory steps of the audit, the initial analysis, and presentation of results to client.

Key Responsibilities/Activities
A. Manage defined sub-projects as directed by lead consultant
B. Coordinate information and interaction with client and administrator
C. Perform initial stages of vendor management, including carrier follow-up, etc.
D. Draft correspondence and client deliverables
E. Evaluate accuracy of medical, dental, prescription drug, and mental health/substance abuse claim handling
F. Conduct client and vendor follow-up and issue resolution
G. Gather data and enter into summary spreadsheets
H. Analyze and trend statistical data
I. Assist with facilitation of operational assessment meetings at health plan service facility
J. Evaluate quality of administrator plan management services against industry standards and 'best practices'
K. Provide recommendations and develop action plan for administrative improvements
L. Monitor and assess quality of customer service inquiries
M. Prepare 'test' claim scenarios in conjunction with performing implementation audits
N. Assist with presentation of client deliverables

DELIVER Result Measures
Client Time Guideline: 75% to 85%

Qualifications:
Education & Certifications
College degree (or equivalent experience)

Work Experience
Benefits/claims administration knowledge (1-2 years of experience)
Organization skills
Detail orientation
Communication skills (oral and written)
Analytical skills (quantitative and qualitative)
Software skills (Microsoft Word, Excel)

Knowledge, Skills. Attributes Including Specific Technical Competencies
Adaptability/flexibility
Communication
HM industry and market knowledge
Learning agility
Problem solving and decision-making
Project management
Teamwork

Other: Travel Expectations/Other Unique Role Characteristics
Client interaction: Moderate
Vendor interaction: High
Primary focus: Client/health plan/other associates
Travel Expectations: Ability to travel 50%-60% of time

Salary/Benefits: Salary commensurate with experience


Job Location: Lincolnshire, IL

Job Number: 302713

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