Quality Auditor I

Western Growers Assurance Trust (WGAT) was founded in 1957 to provide a solution to a need in the agricultural community — a need for employer-sponsored health benefit plans not previously available from commercial health insurance carriers. WGAT is now the largest provider of health benefits for the agriculture industry. The sponsoring organization of WGAT is Western Growers Association, created in 1926 to support the business interests of employers in the agriculture industry. WGAT’s headquarters is located in Irvine, California.
WGAT’s mission is to deliver value to agriculture-based employer groups by offering robust health plans that meet the needs of a diverse workforce. By working at WGAT, you will join a dedicated team of employees who truly care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to WGAT today!
Compensation: $55,215- $76,779 with a rich benefits package that includes profit-sharing. This is a remote position and can reside anywhere in the U.S.

 

Job Description Summary

Reporting directly to the Manager, Quality & Process Improvement, the Quality Auditor I develops and performs audits with the purpose of ensuring conformity with our contract performance guarantees. The incumbent will promote underwriting integrity, regulatory compliance, efficient workflows, and satisfactory user experience in product implementations that meet the needs of the internal system users and facilitate the company's expansion and strategic initiatives. The Quality Auditor I plans, coordinates, and conducts audits on various datasets, including but not limited to eligibility data, health management data, key accounts data, provider data, claims data, and other various systems data.

Qualifications

• BA/BS degree and/or three (3) to five (5) years of work experience in the health benefits industry, particularly in internal and claims auditing, preferred.
• Experience and understanding of employer-sponsored healthcare benefits. General knowledge of health insurance operations and industry.
• Strong knowledge and understanding of reimbursement accounts such as Health Savings Accounts (HSA) and Health Reimbursement Arrangement (HRA), and Flexible Spending Accounts (FSA).
• Proven time management skills –including establishing priorities, working under pressure, working independently with minimal supervision, and working collaboratively to meet deadlines.
• Ability to perform in-depth research and analysis on audit discrepancies and provide detailed documentation of the issue and recommendations for resulting actions.
• Strong ability to communicate verbally and prepare clear, concise written narratives, memoranda, and audit reports.
• Knowledge of the Health Insurance Portability and Accountability Act (HIPAA).
• Advanced computer experience with Microsoft Office Suite: Word, Excel, Visio, PowerPoint, and Outlook, and the ability to develop a strong proficiency working with a proprietary Health Care system.
• Capacity to work cooperatively with colleagues, team members, employer groups, and members.
• Aptitude to maintain strict confidentiality of employer group payroll information.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
• Home router with wired Ethernet (wireless connections and hotspots are not permitted).
• A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
• A functioning smoke detector, fire extinguisher, and first aid kit on site.

Duties And Responsibilities

Auditing

• Conduct eligibility and claim reimbursement audits of key account providers to ensure compliance within the designated program.
• Conduct Health Management (HM) audits to ensure the quality of the data captured in the HM Program.
• Create, develop, and evaluate metrics audits to measure the internal team’s performance quality, accuracy, adherence to procedures, and turnaround time.
• As new programs are implemented, develop auditing requirements to ensure quality, accuracy, and adherence according to program guidelines.
• Collaborate with various ops teams and other areas to develop an auditing process depending on business requirements of the department requesting a process.

Process Improvement & Reporting

• Assist manager and ops teams in the development of processing procedures.
• Collaborate on documenting processes that will reduce data entry errors.
• Review trends and participate in the audit review processes.
• Develop and enhance the various audit processes.
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses. Support various teams with training and development by reporting quality error trends.
• Run, analyze, and distribute audit reports for established intervals.
• Interface effectively with members, senior management as required discussing and resolving audit findings and recommendations.
• Collaborate with teammates to create analyzer reporting that will monitor data automatically and find errors systematically.

Other

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
• Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 10% of the time.
• Other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to travel to both indoor and outdoor areas that can vary in exposure and temperature. The employee is frequently required to operate a motor vehicle, use objects, tools, or controls, and/or required to lift up to 50lbs. The noise level in the work environment is usually moderate.

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