At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

This position is responsible for leading, coordinating and participating in Claims delegation oversight audits of HCSC’s vendors, service providers, medical groups and/or delegated subcontracted providers reviewing adherence to regulatory and contractual requirements. The position also develops audit tools based on Claims, Customer Service, complaint and appeal operations, state and federal regulations, conducts the reviews in accordance with accreditation standards and Claims Guidelines. Creates reports regarding audits and analyzes tracks and trends audit findings. Develops and monitors corrective actions and provides feedback to practitioners on performance.

Required Job Qualifications:

• Bachelor’s degree in Business or Medical OR 4 or more years’ experience in a managed care environment.
• 4 years in a leadership role that includes direct accountability and responsibility and direction of staff.
• 4 years’ experience in directly performing delegated oversight activities.
• Project Management skills and experience.
• Knowledge of regulatory/accreditation requirements and standards (TDI, NCQA, URAC).
• Verbal and written communication skills.
• Organizational skills and the ability to handle multiple priorities.
• PC proficiency to include Word, Excel, PowerPoint and Lotus Notes.
• Ability to travel (up to 30-40) within Texas. Minimal travel outside of the state.
  
  

Preferred Job Qualifications:

• Knowledge of Power Point, Visio and Access.
• College level courses or certification in project management.

HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.