Manager, External Audits

Job Description

We all depend on healthcare throughout our lifetimes, for ourselves, and our families and friends, but it is notoriously difficult to navigate and understand. As an industry that comprises 20% of the US economy we think healthcare should work better for all of us. At Collective Health we believe it’s time for a new day in healthcare where as members we are informed and empowered to make the right care choices when the decisions are urgent and critical.

Collective Health is growing its Customer Experience team in Utah! As part of the Member Services team within Customer Experience, the MX Readiness team is responsible for delivering best in class programs for Quality, Coaching and Performance Audits. We are hiring a leader for our external audits program as a key member and contributor of the team. In this role, you will help shape the future of the program and identify efficiencies and outstanding processes.

What you’ll do:

• Lead and coordinate client requested external audits to ensure compliance to both standard internal process and the client’s summary plan description
• Gain a comprehensive understanding of Collective Health’s operations, processes, policies and procedures to be able to represent us seamlessly during an external audit
• Develop and create effective audit approaches based on a systematic approach and self assessment of internal processes
• Play a key role in managing expectations and effectively communicating on behalf of Collective Health during the execution of independent external audits
• Collaborate with Member Claims Team leadership, and Quality Team leadership to develop and document internal audit standards to support client-specific policies
• Own and lead all operating rhythms and communication surrounding ongoing/upcoming audits, including helping the internal team understand the scope for each audit to ensure alignment with priorities, projects, and timelines
• Partner with the quality team members to proactively identify trends, determine root cause of payment inaccuracies, keep a pulse on the quality auditor findings and recommend process and systems improvements
• Ability to work to tight deadlines, multi-task and prioritize a number of overlapping audit projects
• Evaluate processes with a critical eye and assist with business initiatives
• Identify data driven trends post audit that impact member satisfaction or opportunities for process improvement
• Work cross functionally across Collective Health and Member Services to understand the opportunities that exist to drive corrective action

About you:

• 4+ years of business experience within a healthcare/auditing environment
• Experience as an external auditor in health insurance preferred
• BS degree preferred- will consider senior level experience in lieu of BS
• Advanced analytical and problem solving skills
• Above all, you are self-motivated, intellectually curious, and take ownership for everything you do
• You pay extreme attention to detail
• You are analytical and find trends in data
• You think critically and are willing to question the status quo in a constructive and thoughtful manner
• You enjoy adding structure & taking a methodical approach to problems
• You have been a strong performer in your role historically
• You are a committed teammate
• You thrive on change and are enthusiastic about being along for the ride and learning from our experiences together
• You can manage numerous processes and projects simultaneously
• You possess a passion for Collective Health’s mission to transform the health insurance experience for employers and their employees

Founded in 2013, Collective Health has created an ecosystem of innovative partners across care and benefits delivery, as well as built a powerful and flexible infrastructure to better enable employees and their families to understand, navigate, and pay for healthcare. By reducing the administrative lift of delivering health benefits, providing an intuitive member experience, and improving health outcomes, the company guides employees toward healthier lives and companies toward healthier bottom lines. Collective Health is headquartered in San Francisco, CA with locations in Chicago, IL, and Lehi, UT. For more information, please visit collectivehealth.com .

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance, please contact [email protected] .