Remote Claims Oversight & Compliance Specialist

MedPOINT Management; United States; Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

401(k)

401(k) matching

Bonus based on performance

Dental insurance

Health insurance

Vision insurance

Paid time off

Parental leave

Training & development

Wellness resources

Company parties

Savings bank

Opportunity for advancement

Job summary

MedPOINT Management is seeking a detail-driven Claims Delegations Oversight Specialist to join our team remotely. In this role, you will monitor delegated claims operations for regulatory and contractual compliance, ensuring integrity of our managed care network.

You will conduct oversight reviews, analyze claims data, develop CAPs with delegate organizations, and coordinate with legal, compliance, and provider relations. Strong communication and organization are essential.

Qualifications

• 2+ years in claims processing, managed care, or healthcare compliance.
• Knowledge of NCQA/DMHC standards and IPA operations.
• Strong data interpretation and audit skills.
• Experience developing or managing corrective action plans (CAPs).
• Experience with claims management systems is a plus.

Responsibilities

• Monitor and audit delegated claims entities for contractual, regulatory, and accreditation compliance.
• Conduct oversight reviews and site audits of delegated claims operations.
• Analyze claims data and performance metrics to identify trends and risks.
• Collaborate with delegate organizations to track corrective action plans (CAPs).
• Maintain documentation of oversight activities, findings, and follow-up actions.
• Coordinate with compliance, legal, and provider relations on delegation matters.
• Support reports for health plan partners and regulatory leadership.

Skills

Analytical skills

Cross-functional collaboration

Attention to detail

Written communication

Tools

Excel

Job description

MedPOINT Management is seeking a detail-driven Claims Delegations Oversight Specialist to join our team remotely. In this role, you will monitor delegated claims operations for regulatory and contractual compliance, ensuring integrity of our managed care network.

You will conduct oversight reviews, analyze claims data, develop CAPs with delegate organizations, and coordinate with legal, compliance, and provider relations. Strong communication and organization are essential.