Maxonic maintains a close and long-term relationship with our direct client. In support of their needs, we are looking for a Claims Compliance Analyst.
Job Description:
Job Title: Claims Compliance Analyst
Job Location: Whittier, CA
Work Schedule: On-site
Pay Rate: $31/hour, Based on experience.
Responsibilities:
Maintains positive working relationships with our internal and external customers, health plan s, providers and/or members by seeking a partnership approach that will meet the company goals and vision. The Claims Compliance Analyst will coordinate Health Plan s audits activities with preparation and provide preliminary results on non-compliant claims to the Claims Director. Assists with an audit control checklist for prevention of claims untimeliness of payment. Collaborates in conjunction with the Managed Care Management Team and other auditors, to ensure QA programs are aligned with claims operations and other areas that have direct impact with claims to prevent non-compliance. Adheres to internal department standard operating procedures and applies standard industry guidelines in accordance with regulatory agencies (state and federal). Prepares and submits all monthly, quarterly and as needed reporting to the health plans (Monthly Timeliness, ODAGs, Part C, claims universe, etc.)
Maintains positive working relationships with our internal and external customers, health plan s, providers and/or members by seeking a partnership approach that will meet the company goals and vision. The Claims Compliance Analyst will coordinate Health Plan s audits activities with preparation and provide preliminary results on non-compliant claims to the Claims Director. Assists with an audit control checklist for prevention of claims untimeliness of payment. Collaborates in conjunction with the Managed Care Management Team and other auditors, to ensure QA programs are aligned with claims operations and other areas that have direct impact with claims to prevent non-compliance. Adheres to internal department standard operating procedures and applies standard industry guidelines in accordance with regulatory agencies (state and federal). Prepares and submits all monthly, quarterly and as needed reporting to the health plans (Monthly Timeliness, ODAGs, Part C, claims universe, etc.)
About Maxonic:
Since 2002 Maxonic has been at the forefront of connecting candidate strengths to client challenges. Our award winning, dedicated team of recruiting professionals are specialized by technology, are great listeners, and will seek to find a position that meets the long-term career needs of our candidates. We take pride in the over 10,000 candidates that we have placed, and the repeat business that we earn from our satisfied clients.
Interested in Applying?
Please apply with your most current resume. Feel free to contact Sambhav Raj ( / ) for more details.
Never miss an opportunity! Create an alert based on the job you applied for.