Description

• Regular review of the work of the audit team and the Medicare reporting process.
• Set objectives for claim professionals and track progress throughout the year. Provide positive and constructive feedback and strive to identify growth opportunities.
• Clearly communicate company's policies, requirements, and expectations. Identify and address performance issues. Conduct quarterly and year-end performance reviews.
• Foster a positive work environment.

• Oversee the claim audit process to conclusion.
• Provide critical support for annual reserve review process, including the collection of claim data and accuracy of data.
• Track detailed summary of claim file audit results for each account audited.
• Analyze audit results and prepare detailed reports highlighting findings, trends, and recommendations for improvements.
• Collaborate with claims management to address audit findings and implement corrective actions.
• Train and mentor audit team members, providing guidance on audit processes and best practices.
• Assist in the development and maintenance of audit tools and methodologies to streamline processes and increase efficiency.
• Serve as the principal liaison with Chubb Internal Audit regarding the Brandywine Claim File Audit process and results and respond to requests for supporting documentation and other information.
• Oversite of external and internal legal bill audit resources. Assist staff with audit results. Report key outcomes to senior management.
• Oversite of the Brandywine Medicare Reporting Process.
• Provide support to Brandywine Reinsurance, including supplying claim and financial information to facilitate reinsurance collection and managing the flow of information between the Reinsurance Group and Claim Professionals.
• Oversite of the new claim intake process.
• Manage Brandywine Direct Claims usage of outside consultants for claim file audit support.
• Coordinate the collection of claim data utilizing Brandywine tools and provide related training.
• Conduct quality control review of account summaries.