Audit Analytics Senior Consultant

Blue Cross and Blue Shield Association•Chicago, WA

4d•$97,900 - $141,925•Hybrid

About The Position

The Audit Analytics Senior Consultant is responsible for business analytical audits related to distribution of BCBSA incentive programs and leads development and design of business solutions and applications that support the BCBSA Audit Program framework for measuring financial and operational controls. The role identifies and drives process and system enhancements to improve program efficiency and performs systematic analyses of financial, medical-claims, pharmacy-claims, and member-enrollment and eligibility data. It interprets audit findings and develops recommendations and strategies aligned with BCBSA quality objectives. The position conducts complex root-cause and data analyses, manages audit activities associated with the BCBSA Incentive Program, and develops, executes, and maintains automation infrastructure to support timely and accurate award payments. It leads projects implementing prepayment controls in BCBS Claims Systems to promote accurate claims adjudication consistent with government contracts. The consultant provides technical support to audit teams and BCBS Plans throughout audit lifecycles, contributes to healthcare data and information-solution initiatives, and serves as a liaison and subject-matter expert to develop business and functional requirements for system enhancements addressing audit findings.

Requirements

Bachelor's degree in business administration with a concentration in management information systems or healthcare, or equivalent work experience.
At least five years of specific formal software or system testing experience in a business environment, within managed care or health services delivery.
Proficiency with Microsoft 365, Excel, Visual Basic, and SQL programming.
Analytical skills in predictive modeling and risk stratification, including working knowledge of quantitative analysis, prevalence, ROI, outcome measurements, benchmarks, trends, and outliers.
Data-modeling skills using Microsoft Access and development skills using VBA, SQL, forms, and reports.
Verbal and written communication skills.
Intermediate knowledge of auditing, finance, and claims operations.
Ability to create strategies that support initiatives and translate them into action plans.
Ability to build consensus for business results in a decentralized decision-making structure.
Excellent interpersonal and communication skills.
Ability to translate and present complex business concepts or quantitative information clearly and concisely.
Ability to plan, facilitate, and present at meetings and conferences.
Ability to interact effectively with senior management, both within and outside the Association.

Nice To Haves

Master's degree.
Demonstrated AI literacy and understanding of generative AI tools, including appropriate business applications and limitations.
Experience in software development and information-systems integration, including documenting system requirements, operational requirements, test and evaluation, and user and administrator training.
Experience in healthcare or a government-contracting environment, or experience with a Blue Cross Blue Shield Plan.
Expert use of Microsoft 365, Excel, Visual Basic, Tableau, IDEA/Advantage Sweet, and SQL programming language.

Responsibilities

Conduct business analytical audits related to the distribution of BCBSA incentive programs.
Lead the development and design of business solutions and applications supporting the BCBSA Audit Program framework for measuring financial and operational controls.
Identify and drive process and system enhancements to improve efficiency within the BCBSA Audit Program.
Analyze financial, medical-claims, pharmacy-claims, and member-enrollment and eligibility data; interpret audit findings and develop recommendations or strategies.
Perform complex root-cause and data analyses to improve the quality and efficiency of the core BCBSA Audit Program.
Provide leadership and management for audit activities associated with the BCBSA Incentive Program.
Develop, execute, and maintain automation infrastructure to ensure timely and accurate distribution of award payments according to projected schedules.
Lead projects implementing prepayment controls in BCBS Claims Systems to support accurate claims adjudication consistent with government contracts.
Provide ongoing technical support to audit teams and BCBS Plans throughout the lifecycle of BCBSA or affiliated-company audits.
Contribute to and participate in initiatives and projects involving healthcare data and information solutions.
Serve as a liaison and subject-matter expert with BCBSA or affiliated companies, developing business and functional requirements for system enhancements that address audit findings.