The hiring range for this role is:
78,638.00 - 110,285.00
This 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 this 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 many 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.
This role evaluates Board-mandated performance programs to ensure Blue Cross Blue Shield Health Plans handle customer interactions accurately and timely, leaving a positive brand impression. The performance auditor ensures audit programs are executed correctly and reported results are valid. They develop and present updates and recommendations at various events, assist in strategic planning, and create standard operating procedures. The role involves extensive interaction with Plan staff at all levels and requires diplomacy in difficult conversations. Their work influences Plan operations locally and nationally.
Primary Job Functions
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Responsible for verifying Plan execution of the operational audit programs. This includes auditing Plans’ local and inter-Plan claim processing, local customer service processing, and enrollment processing in accordance with applicable program requirements.
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Review performance results and facilitate cross-functional meetings with Plan stakeholders in order to assess performance issues and action plans for each performance program.
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Facilitate and support the administration of various audit initiatives/programs that impact internal and external stakeholders, including but not limited to: SOC2, payment Integrity, provider data audit, technical development of the audit applications and extract processes.
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Provide audit guidance, education, and support to Plans by helping them to understand and properly execute operational and audit requirements in both formal and informal settings on a scheduled or ad-hoc basis. This includes facilitating and supporting face-to-face training, webinars, the help desk, one-on-one meetings, and collaborating with other BCBSA staff.
Education, Experience, and Certification
Education
Required: Bachelors degree in a business-related discipline and 2 years' work experience.
Experience
Required:
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Minimum three or more years' related experience
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Experience in managing and adapting to multiple, changing priorities
Preferred:
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Work experience with Blue Cross Blue Shield and Inter-Plan programs
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Experience working with claims systems, administration, input, adjudication, statistical systems, and/or health care claim operations.
Knowledge, Skills, and Abilities
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Demonstrated research and analytical skills (quantitative and qualitative).
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Demonstrated presentation and communication skills both oral and written.
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Demonstrated proficiency in the Microsoft Office suite and Internet technologies.
Financial Responsibilities
Revenue Responsibility: No
Budget Responsibility: No
People Management: No
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Top Skills
What We Do
Blue Cross Blue Shield Association is a national federation of 34 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Index.
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