Proactively engage employees, colleagues, and leaders to address identified risks, fraud, & issues and to solve problems with moderate to high complexity
Update reference materials such as user guides, presentations, internal platform WIKI community page postings, and auditor checklist in a timely manner.
Identify and contribute on audit process improvements, policy changes, and submission of “Ideas” to improve the audit processes
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Leverage available automation and AI-enabled tools to enhance assessment efficiency, consistency, and accuracy
Liaise with Medical Advisors to obtain clinical guidance and clarification where required, ensuring informed and well supported claim decisions.
Perform effective suspense management, follow up on outstanding requirements, and liaise with Finance and relevant stakeholders to ensure timely and accurate claim payments.
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