Configuration and Quality Audit Analyst | Hybrid NY

**Duties and Responsibilities**

+ Perform routine, targeted, and risk-based audits of provider pricing configuration and claims across multiple lines of business, products, and provider types.
+ Interpret provider contract reimbursement language and translate terms into expected system outcomes for claims audit testing.
+ Validate claim processing outcomes against provider contract terms, fee schedules, reimbursement methodologies, benefit or business rules, and applicable federal and state requirements.
+ Review technical specifications, configuration documentation and reimbursement policy to confirm business requirements and provider contract provisions are accurately implemented.
+ Identify configuration defects, claim adjudication variances, underpayments, overpayments, quality gaps, and operational control failures.
+ Analyze claim, provider contract, and configuration data to detect outliers, trends, variances, and root causes.
+ Conduct financial and o...

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