Bilingual E-commerce control auditor

Overview

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 auditor conducts health and dental claims audits through reviewing receipt evidence and supporting documentation, contacting providers and/or plan members to validate submissions, verifying provider licensing through internet searches and contact with professional associations and colleges, and following through on actions from these reviews for successful outcomes. The auditor will work with internal departments, including Technical Services, Customer Service, Investigation Services and H&D Operations for resolution on claims submission issues. The auditor reports to the Program Manager, Investigation Services, and helps to protect plan sponsors and members from the negative ...