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
#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 andthis hiringrange 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 bonusincentivepay.
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.