Senior Consultant, Program Assurance Audit
Blue Cross Blue Shield Association
full-time
Posted on:
Location Type: Remote
Location: Remote • District of Columbia, New York, Oregon, Virginia • 🇺🇸 United States
Visit company websiteSalary
💰 $85,126 - $117,521 per year
Job Level
Senior
About the role
- Conduct global and individual claims and financial audits for BCBSA and affiliated companies
- Manage 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
- Develop, maintain, and monitor audit resolution tracking reports and spreadsheets
- Analyze and resolve audit issues promptly
- Serve 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
- Conduct analysis to enhance controls
- Responsible for auditing, monitoring and reporting the effectiveness of the Program
- Oversee and coordinate BCBSA or Affiliated companies' audits
- Effectively communicate 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
Requirements
- Bachelor's Degree or equivalent work experience
- 4+ Years experience auditing government regulations
- Knowledge of claims processing
- Knowledge of financial processing
- Audit Report writing
- Effective writing skills
- Effective communication skills
- Presentation skills
- Knowledge of Microsoft Office Suite
Benefits
- paid time off
- 11 holidays
- medical/dental/vision insurance
- generous 401(k) matching
- lifestyle spending account
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims auditingfinancial auditingaudit report writingclaims processingfinancial processingaudit resolution trackingdata analysispolicy developmentcorrective action planning
Soft skills
effective communicationeffective writingpresentation skillsnegotiationinterpersonal skills
Certifications
Bachelor's Degree