Consultant Performance Audit Operations

The hiring range for this role is:  

78,638.00 - 110,285.00

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

• 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.

• Review performance results and facilitate cross-functional meetings with Plan stakeholders in order to assess performance issues and action plans for each performance program.

• 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.

• 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:

• Minimum three or more years' related experience

• Experience in managing and adapting to multiple, changing priorities

Preferred:

• Work experience with Blue Cross Blue Shield and Inter-Plan programs

• Experience working with claims systems, administration, input, adjudication, statistical systems, and/or health care claim operations.

Knowledge, Skills, and Abilities

• Demonstrated research and analytical skills (quantitative and qualitative).

• Demonstrated presentation and communication skills both oral and written.

• 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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