Project Manager - Third Party Client Audit

Full job description
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Meritain Health is ranked as one of the nation’s largest Third-Party Administrators. Meritain Health is looking for someone who acts as an advocate for and supports the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in claim processing and/or customer service that impact customer satisfaction, medical cost management, and operational efficiency.

Meritain Health’s Project Manager for Third Party Client Audits will be responsible for the following:

Manage end-to-end third-party claim audit projects from initiation through completion.
Performs audits including, but not limited to quality management and procedural documentation, in accordance with company policies.
Develop project timelines, milestones, and deliverables for audit engagements.
Obtains required data from the appropriate source (financial, systems, billing, etc.).
Collaborate effectively and professionally with internal and external partners.
Conducts audit and analysis; provides evaluation of findings.
Develops and delivers recommendations or findings in a report format suitable to the audience.
Assume other duties/responsibilities as assigned.
The ideal candidate should possess the following skills:

Excellent verbal and written communication skills.
Attention to detail.
Analytical and problem-solving skills.
Superior critical thinking skills.
Effective time management, organizational and prioritization skills.
Quickly grasp business concepts, objectives, and strategies.

Required Qualifications

3+ years prior claim experience.
Able to concisely summarize large amounts of information, data and tailor the summary to the audience.
Collaborates effectively and professionally within internal and external partners.
Strong written and verbal communication skills.
Ability to multi-task and prioritize duties.
Attention to detail.
Strong MS Office skills.

Preferred Qualifications

Prior Risk Management experience.
Strong data analysis skills.
Knowledge of self-funded health plans and Third-Party Administrators.

Education

Bachelor's Degree or High School diploma/GED and equivalent work experience.
Anticipated Weekly Hours

40
Time Type

Full time
Pay Range

The typical pay range for this role is:

$46,988.00 - $122,400.00 Read more