Claims Quality Audit Director jobs in Trenton, NJ

Looking to work at a firm with an unbeatable culture? 

Withum is a forward-thinking, technology-driven advisory and accounting firm, helping clients to Be in a Position of Strength^SM in today’s modern business landscape. Withum empowers clients with innovative tools and solutions to address their accounting, tax and overall business management needs. Withum is a place where talent thrives. We recruit only the best and brightest people, with a genuine passion for the business. 

Withum is seeking an experienced health claims auditor possessing in-depth knowledge of group health and disability claims procedures, medical/dental terminology, including CPT, ADA, HCPC and ICDA codes, and a thorough understanding of automated health claims systems as well as manual claims payment systems.

How You’ll Spend Your Time:

• Working closely with our clients to ensure that health, dental, prescription and vision claims are being paid in compliance with regulations and plan documents
• Reviewing client's claims adjudication internal controls policies and procedures
• Completing audit workpapers documenting procedures, findings and conclusions within assigned budgets and deadlines
• Responsible for scheduling and oversight of claims team (3-5 at any given time)
• Review work of team members and present to engagement partner for their final review

The Type's of People We Look For Have the Following Qualities:

• BS Degree
• Must be qualified at analyzing and interpreting group health insurance contract provisions and reviewing administrative policies and PPO contracts
• Experience supervising staff and working within a team environment
• Must be familiar with HIPAA and ACA compliance standards
• Must have a minimum of 7-10 years of health claims processing experience (internal auditing skills a plus)
• Good computer skills (Microsoft office preferred), excellent communication skills
• Ability to travel
• 2-4 years of managerial experience in health claims processing is a plus

The compensation for this position will vary by location. If you reside in San Ramon, CA please see below. In addition to the base compensation, Withum offers a competitive benefits package and bonus program (for eligible roles) based on individual and firm performance. Final offer amounts are based on multiple factors such as the specific role, hiring location, as well as the individual’s skills, experience and qualifications. For additional information on our benefits, visit our website at https://www.withum.com/careers/.

California ranges are from $90,000-$120,000 annually
New York ranges are from $90,000-$120,000 annually
Washington DC ranges are from $90,000-$120,000 annually

Withum will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or because he or she is a protected veteran. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Remotely anywhere within the United States except the States of Colorado & New York.

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