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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Operations Auditing, focusing on process improvement, compliance assessment, and effective communication with healthcare providers and beneficiaries. Proficient in analyzing authorization requests and monitoring KPIs to enhance customer satisfaction and operational efficiency.
Highest-signal resume keywords
Operations AuditingCompliance AssessmentKPI MonitoringAuthorization ProcessingContinuous Improvement
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data AnalysisDocumentation ManagementClaims AuditingProcess OptimizationQuality Control
Soft Skills
CommunicationCollaborationProblem-SolvingCritical ThinkingCustomer Service
Industry Keywords
Healthcare ProvidersBeneficiariesAccredited Provider NetworkMedical ClaimsSystem Denials
About the role
Key responsibilities & impact- Work in Operations Auditing to resolve issues, identify continuous improvement opportunities, and collaborate with other company departments
- Develop and monitor controls, focusing on effectiveness, quality, KPI achievement, and the satisfaction of customers and affiliated physicians
- Analyze and/or register authorization requests received from beneficiaries and healthcare providers in the system
- Process authorizations and audit medical and hospital expense claims, assessing compliance with current rules and negotiated terms
- Assist and communicate with beneficiaries, affiliated physicians, healthcare providers, Unimeds, companies, and departments within the cooperative
- Critically analyze system denials
- Organize, separate, and forward documentation submitted by healthcare providers for filing
- Monitor process deadlines and KPIs
- Stay up to date on the cooperative's processes
- Interact with auditing professionals, including physicians, nurses, administrative staff, pharmacists, and social workers
- Facilitate communication with the accredited provider network, ensuring process efficiency
- Identify optimization opportunities and the need to correct system parameters
- Seek solutions to inquiries, aiming to ensure the satisfaction of customers and the accredited provider network
Requirements
What you’ll need- High school diploma
- Bachelor's degree in progress or completed (preferred qualification)
- Graduate-level specialization in progress or completed (preferred qualification)
Benefits
Comp & perks- Certified as a Great Place to Work (GPTW) for the sixth consecutive year
- Dynamic environment with opportunities to work on a variety of projects
- Encouragement and support for professional development
- Ongoing development opportunities
- Position also open to people with disabilities (PwD)
