Bilingual E-commerce control auditor

The Bilingual E-commerce control auditor is responsible for supporting health and dental claims fraud risk controls by authenticating claim submissions, identifying, and investigating issues for action and resolution, and escalating key control issues to the claims risk management team. 

The Bilingual E-commerce control auditor will conduct health and dental claims audits through reviewing receipt evidence and supporting documentation, contacting providers and/or plan members to validate submissions, verify provider licensing through internet searches and contact with professional associations and colleges, and follow through on actions from these reviews for successful outcomes. The auditor will work with our various internal departments, including Technical Services, Customer Service, Investigation Services and H&D Operations for resolution on claims submission issues.

The Bilingual E-commerce control auditor reports to the Program Manager, Investigation Services, and ...