Claims Operations Delegation Oversight, Supervisor - 239915

Duties:

• Manage all Claims external audits/requests for information from business partners, ensuring consistent accuracy, timeliness, and compliant submissions
• Collaborates with internal SMEs from functional areas, who are liaisons to Claims and Compliance
• Ensuring the data integrity and timeliness of all Claims audit requests (pre- and post-audits)
• Develop and maintain monitoring methods and tools to self-identify and correct potential non-compliant claims
• information (e.g., universes, sampled case files, CAPs)
• Support Claims team in developing root cause analysis and potential solutions to corrective action plans (CAPs)
• requested from auditors/clients
• Create and maintain P&Ps that document Claims methods and protocols
• Working with functional SMEs, develop KPI reporting to perform ongoing internal monitoring, compliant
• performance for all Claims operational areas
• Assist with dashboard KPI reporting for Claims, Executive leadership, and Compliance, including proactive trend analysis to prevent/detect timely potentially noncompliant Claims scenarios
• Collaborate with Claims and other departments to pull together audit findings and provide oversight and monitoring when audits are completed and compliant
• Serve as the Claims representative in key Compliance meetings (i.e., weekly Compliance Huddles, Delegation Oversight Committee, and Compliance Committee), presenting Claims performance results, as necessary