Senior/Lead Audit Analyst

Blue Cross and Blue Shield Association • Philadelphia, PA

74d

About The Position

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve.

Requirements

• Bachelor's degree with a minimum of 3 years of experience in healthcare operational auditing or equivalent experience in quality analysis of healthcare products.
• Experience in conducting operational audits or quality reviews, including root cause analysis, validation of implemented controls, and assessment of control effectiveness.
• Knowledge of healthcare claims processing, provider pricing and contracting, and benefit configuration for healthcare plans.
• Knowledge of medical benefit structures and healthcare product offerings.
• Knowledge of pharmacy benefits and products is a plus, though not required.
• Experience with BCBSA audit programs such as Local Operations Scorecard (LOS), Line Desk Level Audit (LDLA), and Federal/Postal Employee Health Benefit Plans (FEHB/PSHB) is preferred.
• Proficiency with the HealthRules claims adjudication system.
• Understanding of federal regulations related to FEHB and PSHB programs is advantageous but not mandatory.
• Strong verbal communication skills for engaging with various levels of management, and excellent written communication skills for preparing audit responses and documentation.

Nice To Haves

• Knowledge of pharmacy benefits and products.
• Experience with BCBSA audit programs such as Local Operations Scorecard (LOS), Line Desk Level Audit (LDLA), and Federal/Postal Employee Health Benefit Plans (FEHB/PSHB).

Responsibilities

• Facilitate operational and financial external audit projects, ensuring timely completion in alignment with established audit criteria, best practices, and audit policies.
• Perform monthly audits of claims accuracy and customer service for the Federal Employee Health Benefit Program and the Postal Service Health Benefit Program.
• Develop and implement effective strategies to address and resolve audit findings.
• Ensure all assigned deliverables meet audit standards and expectations for external audit projects.
• Address all confirmed audit issues identified from an external audit project with internal stakeholder departments to ensure root cause has been properly identified, verify the implementation of remediation steps, and verify the completion of any financial/claim impacts.
• Act as the primary liaison and subject matter expert for external auditors and internal stakeholders.
• Review departmental responses to potential errors for accuracy and completeness, refining communications to suit internal and external audiences.
• Prepare and conduct quality reviews of audit documentation prior to final issuance.
• Monitor and track resolution of identified manual and systemic issues.
• Serve as a resource to audit teams and client management, providing guidance on audit requirements and processes.
• Mentor and train new audit analysts to ensure consistent performance and development.
• Perform additional responsibilities as assigned.

Benefits

• Hybrid work model with associates working in the office 3 days a week and remotely 2 days a week.
• Equal Opportunity Employer.

What This Job Offers

• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: Bachelor's degree