The Performance Measurement Specialist III is responsible for executing both random and focused audits across various operational areas, with a strong emphasis on Appeals and Grievances. This role assesses company operations, compliance, and process risks, and presents detailed audit findings and actionable recommendations to management and stakeholders.

The specialist supports strategic initiatives to enhance the audit function, improve internal controls, and refine operational and management policies and procedures. This role also plays a key part in supporting external audits, including those from CMS, DMAS, and group clients. Ideal candidates will bring a solid background in claims operations along with deep expertise in Appeals and Grievances processes.

Education

HS - High School Grad or Equivalent

Certification/Licensure

No specific certification or licensure requirements

Experience Requirements

Minimum 2 years of experience in Claims Processing, Customer Service, Enrollment, or System Administration

Strong working knowledge of Appeals and Grievances operations and compliance standards

Experience conducting audits and analyzing process and compliance risks

Ability to prepare and present detailed audit reports with strategic recommendations

Familiarity with supporting external audits (CMS, DMAS, or similar regulatory bodies)

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is:$46,508.80-$77,500.80. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.