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Independence Blue Cross · 1 day ago

Senior Claims Audit Analyst

Philadelphia, Pennsylvania

Full-time

Onsite

Senior Level

5+ years exp

Independence Blue Cross is seeking a dynamic individual to join their team as a Senior Claims Audit Analyst. The role involves ensuring timely execution of external audits, reviewing internal responses for accuracy, and developing operational audits while serving as a resource for audit requirements and processes.

Health CareHealth InsuranceInsuranceMedical

Responsibilities

Ensure the meeting of the timeline for external audits

Address the most problematic and difficult functions associated with the External Audit function to ensure timely and complete execution of external audits in accordance with sound audit practices and regulations

Review all internal responses from departments for accuracy and completeness

Modify responses to address properly the audience for an internal or external party

Prepare audit supporting documentation

Perform and develop operational audits and provide results

Monitor the resolution of systemic issues

Serve as information resource to Audit and client management regarding audit requirements and processes

Qualification

Healthcare claims auditAudit procedures knowledgeBCBSA guidelines familiarityInterplan Teleprocessing SystemBenefits coding knowledgePharmacy services knowledgeBusiness Administration degree

Required

BA/BS in Business Administration, Accounting, or related discipline, or equivalent knowledge acquired by on-the-job training and experience

Five (5) or more years of healthcare claims audit or progressively more responsible experience in Customer Service, Enrollment, Claims, Provider Services, Medicare, Quality, or related administrative activities

Extensive Knowledge of audit procedures, requirements, and practices related to these audits

Have familiarity and Acquire Working Knowledge Working with BCBSA guidelines for Member Touchpoint Measures (MTM), BCBSA Line Desk Level Audit (LDLA), and Multi-State Plan (MSP)

Extensive Knowledge of all key operating systems such as Interplan Teleprocessing System (ITS) and OSCAR for eligibility, customer service, enrollment, and claim processing issues

Working Knowledge of benefits coding, and package types for the HMO and PPO products

Working Knowledge of pharmacy services

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app