Healthcare Medical Insurance Auditor

Who We Are: Lumelight is an integrated workplace administration and compliance business. We serve the brokers and third-party administrators who support employers in the complex, crucial areas of benefits design, compliance and administration. We handle the complexities of benefits compliance and administration, empowering you to focus on what you do best. As the thoughtful synthesis of carefully curated specialists, Lumelight was created to serve a highly fragmented market by simplifying benefits compliance, reducing exposure to risk and giving clients the freedom and confidence to focus on their core business and accelerate performance. Position Overview: The Account Coordinator (Pharmacy Auditor) is responsible for serving Lumelight clients by participating in all aspects of our claims audit processes as well as strategically supporting the project’s kick-off through completion. This position will work closely with the rest of the Client Delivery Team, ensuring that everything we do is for the betterment of our clients. Utilizing proprietary software, this position involves reviewing pharmacy or pharmacy benefit plan documentation and provisions against actual claims paid or claims paid scenarios to identify potential issues. Duties and Responsibilities:

• Participate in all phases of the audit process and reporting to meet internal and external timeframes.
• Conduct on-site and in-house healthcare claims audits to ensure proper healthcare claim adjudication practices were followed by the third-party administrator according to client intent.
• Works with a focus to make sure the deliverables are accurate, thorough and high quality.
• Assist with and conduct quality assurance checks on all client deliverables.
• Assist with training of new auditors.
• Works cross-functionally Client Delivery team members (auditors, project managers) to assure service and partnership plans directly support the account plan for the client and that services are setup, maintained and delivered in the form that meets the clients’ needs and is within the scope of the contract.
• Achieve weekly commitments and assigned Individual and Team goals during applicable performance periods.
• Performs other duties as assigned.

Education and Experience:

• Preferably 3 years of employment with a company; or equivalent experience in a healthcare pharmacy audit setting; or a certificate/diploma in the pharmacy field may be substituted for healthcare experience.
• Excellent verbal and written communication to clearly explain concepts, provide feedback and actively listen to other team members.
• Proven excellence in the support and service to complex clients.
• Proven ability to manage multiple audits simultaneously and meet deadlines.
• Attention to detail and ability to work with large volumes of data.

Desired Skills:

• Superior problem-solving ability, preferably within a client environment
• Strong analytical and critical thinking ability.
• Strong ethical and professional conduct with a commitment to objectivity and confidentiality.
• Proficiency with Microsoft Office (Word, Excel, Outlook, PowerPoint, etc.) and video conferencing.

Work Environment: This position is a remote position within approved Lumelight states. This job operates in a professional office environment, whether in person or remotely. This role routinely uses standard office equipment such as computers, phones, and printers. Equipment will be provided to you. Benefit Offerings:

• Medical, Dental and Vision Benefits
• Health Savings and Flexible Spending Account Options
• 401(k) with Automatic Company Contribution
• Employee Assistance Program
• Company-paid Life and Disability Insurance
• Paid Time Off

We are currently recruiting from the following states: Arizona (AZ), Florida (FL), Georgia (GA), Indiana (IN), Iowa (IA), Kentucky (KY), Louisiana (LA), Maryland (MD), Michigan (MI), Minnesota (MN), Missouri (MO), Montana (MT), Nebraska (NE), Nevada (NV), New Mexico (NM), North Carolina (NC), North Dakota (ND), Ohio (OH), South Carolina (SC), South Dakota (SD), Tennessee (TN), Texas (TX), and Utah (UT). Lumelight, LLC. is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law. Apply To This Job