Claims Auditor and Cost Containment Lead
4 weeks ago
Valenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.
About Our Opportunity
As the Claims Auditor and Cost Containment Lead, you will ensure a smooth and efficient claims process by reviewing, organizing, and auditing claim documents. Adhering to the terms and conditions laid out in plan documents and stop loss policies, you will utilize information from various sources to proactively initiate cost containment solutions.
You will partner with our team members, contributing to a robust claims process that prioritizes efficiency, accuracy, and cost optimization.
Things You’ll Do Here:
- Serve as backup to the Stop Loss Specialist in maintaining the claims mailbox or other claim submission types within stated guidelines and turnaround time metrics.
- Ensure reimbursement requests are audited timely and all information is documented and journalized.
- Ensure claims are processed based on the terms and conditions of the plan document and stop loss policy.
- Secure appropriate documentation to evaluate eligibility of initial and supplemental reimbursement requests such as: include enrollment and eligibility documentation, extension of benefits, FMLA/COBRA election and contribution documentation, precertification’s, accident details and signed subrogation form, UB-04 and itemized bills for billed charges more than $50,000.
- Develop relationship and processes with vendors, brokers and TPA’s to ensure best in class client satisfaction and payment integrity.
- Work with Stop Loss Analyst to review various claim notifications to make determinations about prospective reserves based on clinical information provided and proactive cost containment solutions.
- Work with EVP and other departments for reporting, research projects, and other duties as assigned.
Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.
What You’ll Bring to the Team:
- 3+ years of experience handling healthcare claims including claims auditing.
- Knack for organization and strong attention to detail.
- Experience in Microsoft Office Suite, specifically skilled in creation and utilization of MS Excel spreadsheets and MS Word.
- Strong skillset in collaboration and communication.
A plus if you have:
- Bachelor’s degree in Finance, Accounting, Economics or related field.
- Understanding of plan documents, stop loss, and/or cost containment.
Where you'll work:
This role is remote or hybrid if you live in the Indianapolis area
Why You Will Love Working Here
We offer employee perks that go beyond standard benefits and compensation packages – see below
At Valenz, our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to be strong, vigorous, and healthy. You’ll find limitless growth opportunities as we grow together. If you're ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you
Perks and Benefits
- Generously subsidized company-sponsored Medical, Dental, and Vision insurance.
- Spending account options: HSA, FSA, and DCFSA
- 401K with company match and immediate vesting.
- Flexible working environment.
- Generous Paid Time Off to include Vacation, Sick, and Paid Holidays.
- Paid maternity and paternity leave.
- Community giveback opportunities, including paid time off for philanthropic endeavors.
At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.
Powered by JazzHR
qA9Ro7tm8B
-
Senior Auditor
2 weeks ago
Indianapolis, United States Creative Financial Staffing Full timeSenior Auditor Why work here? Looking for a change? Say goodbye to the exhausting 70-hour work weeks, because we have the perfect job for you as a Senior Auditor! Here's what we offer to make your work-life balance a reality. Don't let work consume your life. Embrace a better future with our exciting job opportunity! Unlimited PTO Hybrid Schedule! Celebrate...
-
Specialist, Claims
1 month ago
Indianapolis, United States RXO Inc. Full timeAccelerate your career at RXO. RXO is a leading provider of transportation solutions. With cutting-edge technology at the center, we're revolutionizing the industry with our massive network and commitment to finding solutions for every challenge. We create more efficient ways for shippers and carriers to transport goods across North America. $500 sign-on...
-
Specialist, Claims
4 weeks ago
Indianapolis, United States RXO Inc. Full timeAccelerate your career at RXO. RXO is a leading provider of transportation solutions. With cutting-edge technology at the center, we're revolutionizing the industry with our massive network and commitment to finding solutions for every challenge. We create more efficient ways for shippers and carriers to transport goods across North America. $500 sign-on...
-
Nurse Audit Lead
1 month ago
Indianapolis, Indiana, United States Elevance Health Full timeNurse Audit Lead Supports the Carelon Payment Integrity line of business Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles from our Elevance Health Pulse Point locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights,...
-
Nurse Audit Lead
2 weeks ago
Indianapolis, Indiana, United States Elevance Health Full timeNurse Audit Lead Supports the Carelon Payment Integrity line of business Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles from our Elevance Health Pulse Point locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights,...
-
Nurse Audit Lead
4 weeks ago
Indianapolis, Indiana, United States Elevance Health Full timeNurse Audit Lead Supports the Carelon Payment Integrity line of business Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles from our Elevance Health Pulse Point locations. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights,...
-
Auditor, Internal Audit
2 weeks ago
Indianapolis, United States Salesforce Full timeAbout Salesforce. Were Salesforce, the Customer Company, inspiring the future of business with AI Data CRM. Leading with our core values, we help companies across every industry blaze new trails and connect with customers in a whole new way. And, we Audit, Auditor, Internal, Technology, Audit Manager, Salesforce, Accounting
-
Nurse Audit Lead
1 month ago
Indianapolis, United States Elevance Health Full timeAnticipated End Date: 2024-06-11 Position Title: Nurse Audit Lead Job Description: Nurse Audit Lead Supports the Carelon Payment Integrity line of business Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles from our Elevance Health Pulse Point locations. Carelon Payment Integrity is a proud...
-
Nurse Audit Lead
4 weeks ago
Indianapolis, United States Elevance Health Full timeAnticipated End Date: 2024-06-11 Position Title: Nurse Audit Lead Job Description: Nurse Audit Lead Supports the Carelon Payment Integrity line of business Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles from our Elevance Health Pulse Point locations. Carelon Payment Integrity is a proud...
-
Claims Team Manager
4 weeks ago
Indianapolis, Indiana, United States Liberty Mutual Insurance Full timePay PhilosophyThe typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as...
-
Claims Team Manager
1 month ago
Indianapolis, Indiana, United States Liberty Mutual Insurance Full timePay PhilosophyThe typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as...
-
AVP, Executive Claim Director
4 weeks ago
Indianapolis, United States Chubb Full timeJob DescriptionAVP-Executive Claim Director This individual contributor role requires a high degree of technical acumen and know-how in all aspects of effectively handling a Casualty claim within the Casualty team. The successful candidate will have demonstrated consistent proficiency in coverage, investigation, evaluation, litigation management,...
-
AVP, Executive Claim Director
3 weeks ago
Indianapolis, United States Chubb Full timeJob DescriptionAVP-Executive Claim Director This individual contributor role requires a high degree of technical acumen and know-how in all aspects of effectively handling a Casualty claim within the Casualty team. The successful candidate will have demonstrated consistent proficiency in coverage, investigation, evaluation, litigation management,...
-
Indianapolis, United States Elevance Health Full timeAnticipated End Date: 2024-06-14 Position Title: Audit & Reimbursement III - Medicare Cost Report Audit Job Description: Audit & Reimbursement III - Medicare Cost Report Audit Locations: This is a virtual position; the ideal candidate will live within 50 miles of an Elevance Health PulsePoint location. National Government Services is a proud member of...
-
Indianapolis, United States Elevance Health Full timeAnticipated End Date: 2024-06-14 Position Title: Audit & Reimbursement III - Medicare Cost Report Audit Job Description: Audit & Reimbursement III - Medicare Cost Report Audit Locations: This is a virtual position; the ideal candidate will live within 50 miles of an Elevance Health PulsePoint location. National Government Services is a proud member of...
-
Technical Specialist, Construction Claim
4 weeks ago
Indianapolis, United States Travelers Full timeWho Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine...
-
Technical Specialist, Construction Claim
4 weeks ago
Indianapolis, United States Travelers Full timeWho Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine...
-
Claims Reimbursement Specialist
4 weeks ago
Indianapolis, United States Remodel Health Full timeBenefits Specialist Job Description Remodel Health has helped employers to revolutionize the way health benefits are delivered to their employees since 2014. We’ve made it to the Inc 5000 list 5 years running, but we are most proud of getting people better plans at lower costs. Organizations have saved nearly $100M while actually improving their health...
-
Claims Reimbursement Specialist
4 weeks ago
Indianapolis, United States Remodel Health Full timeBenefits Specialist Job Description Remodel Health has helped employers to revolutionize the way health benefits are delivered to their employees since 2014. We've made it to the Inc 5000 list 5 years running, but we are most proud of getting people better plans at lower costs. Organizations have saved nearly $100M while actually improving their health...
-
Claims Reimbursement Specialist
4 weeks ago
Indianapolis, United States Remodel Health Full timeBenefits Specialist Job Description Remodel Health has helped employers to revolutionize the way health benefits are delivered to their employees since 2014. We’ve made it to the Inc 5000 list 5 years running, but we are most proud of getting people better plans at lower costs. Organizations have saved nearly $100M while actually improving their health...
