Remote Claims Delegations Oversight Analyst
MedPOINT Management
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Benefits offered by this job
Job summary
MedPOINT Management seeks a detail-driven Claims Delegations Oversight Specialist to join our team in Sherman Oaks, CA. This compliance-focused role ensures delegated claims operations meet regulatory and contractual standards, supporting our managed care network.
You will monitor, audit, and analyze claims data, collaborating with delegate organizations to develop corrective action plans and maintain thorough documentation for health plan partners and regulators.
Qualifications
- 2+ years in claims processing, managed care, or healthcare compliance.
- Knowledge of NCQA/DMHC standards and delegation oversight.
- Experience developing CAPs.
- Strong data interpretation and reporting skills.
Responsibilities
- Monitor and audit delegated claims entities for compliance.
- Conduct routine oversight reviews and site audits.
- Analyze claims data to identify trends and risk.
- Collaborate with delegate organizations on CAPs.
- Maintain documentation of oversight activities and findings.
- Coordinate with compliance, legal, and provider relations.
- Support preparation of reports for health plan partners and regulators.
Skills
Tools
Job description
MedPOINT Management seeks a detail-driven Claims Delegations Oversight Specialist to join our team in Sherman Oaks, CA. This compliance-focused role ensures delegated claims operations meet regulatory and contractual standards, supporting our managed care network.
You will monitor, audit, and analyze claims data, collaborating with delegate organizations to develop corrective action plans and maintain thorough documentation for health plan partners and regulators.
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