HealthEZ

Auditor

• Review and validate new and modified benefit plan configurations against approved requirements, plan documents, and configuration standards
• Validate system configuration outcomes through structured testing and claim adjudication review
• Review benefit structures, coverage limitations, accumulators, cost-share arrangements, provider network configurations, pricing methodologies, denial logic, exception codes, member responsibility indicators, remit messaging, and claim processing outcomes
• Document audit findings, communicate recommendations, and track resolution activities through completion
• Perform follow-up reviews to validate corrective actions
• Analyze audit findings and recommend improvements to configuration quality and consistency
• Maintain audit documentation and support quality, accuracy, and implementation-readiness reporting
• Configure and maintain benefit plans according to approved requirements and business specifications
• Interpret plan documents and translate business requirements into system configuration
• Support implementations for new and existing clients, benefit changes, and system enhancements
• Participate in testing for configuration changes, system upgrades, regulatory updates, and operational initiatives
• Serve as a resource for complex configuration scenarios and adjudication-related questions
• Collaborate with cross-functional teams on implementation and operational performance
• Promote configuration standards, procedures, and departmental best practices
• Identify opportunities to strengthen quality controls and reduce configuration-related defects
• Conduct ongoing trend analysis of audit findings and quality results
• Provide feedback and recommendations to address recurring issues and improve configuration accuracy
• Update audit procedures, testing standards, configuration guidelines, and related documentation
• Partner with leadership and team members to improve operational efficiency, consistency, and quality outcomes
• Participate in departmental initiatives and special projects

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Plan Build Auditor