(FDR = First Tier, Downstream and Related Entities)
This position will lead, coordinate and participate in all delegation oversight audits of the company’s vendors, service providers and delegated subcontracted providers, according to regulatory and contractual requirements, specifically focusing on claim processing activities.
He/she will assist in the liaison role between the subcontracted providers in the delegation oversight process. The position will also participate in audits, develop reports regarding audits, and analyze, track and trend claim audit findings. This position will review all claim Service Level Agreement (SLA) results, identify any metrics not meeting expectations, make recommendations for remediation and/or identify the need for appropriate corrective action.
He/She will lead, coordinate and monitor all claim Corrective Action Plans (CAP) and Continuous Improvement Projects (CIP) for FDRs whether associated with audit findings or operational issues.
He/She will engage in the strategic development of the Claims FDR Oversight Program.
Core Company-Wide Competencies:
Job Specific Competencies:
In the role of business lead for assigned FDR; incumbent is responsible to complete comprehensive oversight and monitoring of their vendor that incorporates the following elements: efficient and effective operations; compliance with laws, regulations, policies, procedures; and other company performance issues designed to reduce risk and add value to the company
Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.
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Neighborhood is an EOE M/F/D/V and an E-Verify Employer