
APS5 Claims Specialist
1 week ago
Job Role Overview
Job Description:We are seeking a highly skilled professional to undertake control and conformance testing for PPC and SMP Programs.
- Undertake reviews of targeted claims through engagement with providers, plan managers and participants
- Contribute to the design of new detective and preventative controls using manual validation checks and systematic analytics
- Investigate, report on and escalate claims and payments anomalies in collaboration with teams
In this role, you will be responsible for ensuring program relevancy by modifying test documentation and providing input to assurance and compliance reports.
This is an exciting opportunity for a dedicated professional who can adapt to change and demonstrate clear communication skills. If you are able to effectively manage time and resources, this could be the ideal role for you.
Key Responsibilities:- Control and Conformance Testing
- Review of Targeted Claims
- Design of New Controls
- Investigation and Escalation of Anomalies
The successful candidate will have strong analytical skills and be able to work independently as well as collaboratively within a team environment. If you are interested in this challenging and rewarding role, please submit your application.
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