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City of New York · 1 month ago

Self-Funded Health Plan Auditing Supervisor

Manhattan, NY

Full-time

Onsite

Entry, Mid Level

$79K/yr - $79K/yr

1+ years exp

The City of New York's Office of Labor Relations is responsible for managing labor relations and health benefits programs. The Self-Funded Health Plan Auditing Supervisor oversees staff reconciling claims payments and ensures compliance with health plan processes and contractual obligations.

GovernmentLegalPublic Relations

Responsibilities

Monitor health plan processes to ensure compliance with contractual obligations, regulatory requirements, and internal policies related to health claims and monthly admin fee payments

Oversee the performance of monthly reconciliations between the daily claims reports and the monthly reports which detail the claim associated fees

Coordinate with the external auditor to develop and execute audit plans

Coordinate review of audit reports outlining findings, root causes, and recommendations

Guide staff in the Investigation of anomalies or discrepancies in payment data, including duplicate payments, misclassifications, and ineligible charges

Handle all personnel matters including performance review and any disciplinary meetings

Qualification

Health plan auditingInsurance managementRegulatory complianceAudit coordinationStaff supervision

Required

A baccalaureate degree from an accredited college or university plus one year of full-time paid experience within the last six years in fire, casualty or surety insurance as a corporate insurance manager, insurance agent, insurance underwriter or insurance broker

High school graduation or evidence of having passed an examination for the high school equivalency diploma or the U.S. Armed Forces G.E.D. certificate with a score of at least 35 on each of the five tests and an overall score of at least 225 in the examination for the certificate; plus five years of satisfactory experience within the last six years as described in (a) above

A satisfactory equivalent combination of education and experience. However, all candidates must be high school graduates with at least one year of experience in the last six years as described in (a) above