Claims Audit Specialist_Quality Assurance

About the role

Versant Health is one of the nation's leading administrators of managed vision care, serving over 35 million members across the United States. Our purpose is to make healthy vision a reality for everyone by improving access to care and education in the communities we serve.

Responsibilities

• Conduct quality reviews of functions performed within Operations in accordance with Department guidelines.
• Analyze findings, report results, and make suggestions on process improvements where common errors have been identified.
• Recommend corrections/changes to systems, policies, and procedures to ensure higher quality of work.
• Provide feedback to associates and management to improve workflow and eliminate repeated errors.
• Assist the department Manager with routine reviews of the quality program to ensure it meets business and regulatory requirements.
• Provide regular feedback and recommendations to the department Manager regarding staff performance and improvement.
• Maintain documentation as mandated by control activity for SSAE 16 and Financial audits.
• Assist in department/corporate projects to ensure system upgrades, policy changes, or benefit adjustments are introduced accurately and timely.
• Perform other duties as assigned.

Requirements

• Preferred Bachelor's degree in a related field or equivalent combination of experience and education.
• One (1) year of related experience in Quality Review, Quality Assurance, or Process Improvement (preferred).
• Three (3) years of related experience in Claims (required).
• Bilingual skills a plus.
• Proficiency in Microsoft Office.

HIPAA & Security Requirements

All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) regarding disclosures of protected health information (PHI). Associates may have access to covered information, cardholder data, or other confidential customer information and must adhere to data security guidelines established within the Company’s Privacy & Security Training Program.

Physical Demands & Work Environment

• While performing the duties of this job, the associate is required to stand, use hands and fingers to handle, feel, pick, or pinch, and talk or hear most of the time.
• Occasionally required to stand, walk, and reach with hands and arms.
• Must frequently lift and/or move up to 20 pounds.
• The noise level in this location is moderate (use of computers, printers, and machines).
• Ability and willingness to travel as required.

Benefits

• Medical, dental, and paid vision coverage.
• Paid time off and company holidays.
• Retirement savings with employer contribution.
• Employee wellness resources.
• Professional development opportunities.
• Flexible work arrangements (additional benefit).
• Employee assistance programs (additional benefit).

Pay

This role is compensated on an hourly basis at $25 per hour, based on factors such as experience, skills, and role requirements.

Schedule

Versant Health strongly prefers candidates who are able to work hours aligned with the Eastern Time Zone or Central Time Zone. Applicants must reside within the continental United States.