Theron Butler, CIPP/US
Pittsburgh, PA KnowledgeNet Chair
Manager Operational Claims Audit
WellCare Health Plans, Inc.
Theron Butler is the manager of the Operational Claims Audit department for WellCare Health Plan. Within the finance, audit, and recovery division, he oversees a staff of professional insurance auditors and two team leads that are responsible for auditing data elements, ensuring Medicare and Medicaid payment and financial accuracy for the organization in all operating markets.
He also monitors the organization’s delegated entities claim processing performance levels conducting annual claim audits and comparing those results to contracted service level agreements. He and his team perform targeted compliance audits upon request in support of compliance and quality concerns mitigating risk and improving star ratings.
Butler joined WellCare this summer and has spent over 11 years in the insurance industry, holding various management positions focusing on compliance, audit, and high dollar claim payment recoveries.
He earned the Certified Information Privacy Professional/United States (CIPP/US) certification in 2012. Butler also holds the Managed Healthcare Professional designation from America’s Health Insurance Plans (AHIP), which he received in 2005, and is a Certified Healthcare Reform Specialist through the Employer Healthcare and Benefits Congress.