Evolent Health Hiring for Supervisor, Audit at Pune, India Full Time

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference working in everything from scrubs to jeans.

Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation’s foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.

We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

Position summary

Evolent is looking for bright and energetic individuals to be a Supervisor for Claim Auditor & Quality Assurance.

Essential functions

• Effectively handle multiple initiatives as the same time.

• Effectively communicate across all levels of management and management personnel.

• Ensure compliance with contract administration, demographic maintenance, and service level requirements through claim reviews and client appeals.

• Conducts Audit-the-Auditor claim audits.

• Support recoupment and recovery activities for claim overpayments.

• Support request for funding and other financial related activities supporting claims adjudication.

• Support business goals & system fixes by claim reviews, analyzing, identifying, and resolving issues.

• Participate in documenting and prioritizing potential solutions to issues & fallout for system issues.

• Establish and implement interim workaround solutions as needed and communicates to all impacted users.

• Assist in establishing and communicating new and existing policy and procedures.

• Facilitate discussions and solutions with matrix partners and acts as a subject matter expert.

• Accountable for analyzing and measuring results of implemented policies, changes and system modifications.

• Effectively handle multiple initiatives as the same time.

• Effectively communicate across all levels of management and management personnel

• Other duties as assigned

Key competencies/skill/success factors:

• In-depth knowledge of Claims and claims adjudication.

• Strong people management skills

• Ability to ensure strong Client Relationship.

• Decision making abilities.

• Knowledge of health insurance, HMO and managed care principles.

• Critical thinking skills to build efficiencies

• Create and manage productivity reports, policy and procedures

• Manage and execute projects

• Excellent interpersonal, oral and written communication skills

• Able to work independently; strong analytic skills

• Strong computer skill

Qualification and Experience:

Required

• Associate or Bachelor degree preferred.

• Extensive experience in health insurance claims processing with a minimum of 6 to 8 years

• HMO Claims or managed care environment preferred

Big plus

• Proficiency in MS Office and knowledge in macro is additional advantage

Mandatory Requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Preferred Requirements:

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and national law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.

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Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status .