Description

This role conducts global and individual claims and financial audits for BCBSA and affiliated companies, managing the audit resolution process to finalize reports. Verify the accuracy of claims audit documentation and evaluate Plan responses. Coordinate and track responses to audit findings, and develop, maintain, and monitor audit resolution tracking reports and spreadsheets. Analyze and resolve audit issues promptly, serving as the primary contact for negotiating audit issue resolutions. Identify erroneous payments through claims testing and report activities. Maintain and monitor the Claims Audit Monitoring Tool and audit resolution tracking, conducting analysis to enhance controls.

Responsible for auditing, monitoring and reporting the effectiveness of the Program

Oversee and coordinate BCBSA or Affiliated companies' audits

Effectively communicates verbally and written to BCBSA or Affiliated companies

Review BCBSA or Affiliated companies information request, audit inquiries and audit resolution supporting documentation

Create, review and update departmental policies and procedures

Advise and ensure the implementation of corrective action plans

Develop and provide BCBSA or Affiliated companies training

The posting range for this position is:
$85,126.00-$117,521.58
Qualifications

Education

• Required Bachelor's Degree or equivalent work experience

Experience

• 4+ Years experience auditing government regulations Required

Knowledge Skills and Abilities

• Knowledge of claims processing
  Knowledge of financial processing
  Audit Report writing
  Effective writing skills
  Effective communication skills
  Presentation skills
  Knowledge of Microsoft Office Suite
• Certifications & Licenses
• Preferred: Certified Internal Auditor (CIA) - Institute of Internal Auditor
• Extra Posting Information:
  Four or more years experience auditing government regulations
  Experience auditing Blue Cross Blue Shield Plans
  

#LI-Remote

The posted salary range is the lowest to highest salary we , in good faith , believe we would pay for this role at the time of this posting . We may ultimately pay more or less than the hiring range and t his hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching , lifestyle spending account and m any other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.