Performance Analyst

Capital Blue Cross•Harrisburg, PA

11h•Remote

About The Position

This position is responsible for the audit functions related to determining and validating FEP Plan performance, as it relates to Membership, Claims and Customer Service activity. The position also provides analysis and feedback as it relates to assigned Performance Guarantee Accounts and participates in external Client audit requests. At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.

Requirements

Research, analytical and problem-solving skills.
Mathematical skills required.
Ability to communicate effectively with diverse audiences both in writing and verbally.
Ability to address workload to meet numerous deadlines, accommodate and adapt to changing priorities.
Understanding of the healthcare industry as it relates to BCBSA.
Understanding of claims coding and processing including BlueCard, ITS and FEP; membership processes at both the group and member level; and customer service processes, also including FEP.
Knowledge of FEP benefit products and processing guidelines.
Knowledge of Facets.
Familiar with FEPDirect and Microsoft Office applications especially Excel.
A minimum of 5 years' experience in Claims, Membership or Customer Service (or combination of the three); depending on current business needs.
Knowledge of FEP required.
Audit and/or analytical experience required.
High School diploma or GED.

Responsibilities

Audits FEP claims, customer service inquiries, member and group enrollment activities in accordance with Plan Incentive Program (PIP) guidelines.
Completing Performance Guarantee audits.
Supports IA and SIU with assistance as needed.
Utilizing internal formatting, maintains adequate documentation to support all audit reviews and outcomes.
Providing this material to the appropriate Performance Analyst for internal and BCBSA report compilation.
Participate in team collaborative efforts to resolve audit issues.
Utilizes the internal SharePoint Audit tool to communicate findings and follow up assuring corrective action is taken and documented.