Job Details

Claims And Financial Audit Manager

This role conducts global and individual claims and financial audits for BCBSA and affiliated companies, managing the audit resolution process to finalize reports. Verify the accuracy of claims audit documentation and evaluate Plan responses. Coordinate and track responses to audit findings, and develop, maintain, and monitor audit resolution tracking reports and spreadsheets. Analyze and resolve audit issues promptly, serving as the primary contact for negotiating audit issue resolutions. Identify erroneous payments through claims testing and report activities. Maintain and monitor the Claims Audit Monitoring Tool and audit resolution tracking, conducting analysis to enhance controls.

Responsibilities include:

• Auditing, monitoring, and reporting the effectiveness of the Program
• Overseeing and coordinating BCBSA or Affiliated companies' audits
• Effectively communicating verbally and written to BCBSA or Affiliated companies
• Reviewing BCBSA or Affiliated companies information request, audit inquiries, and audit resolution supporting documentation
• Creating, reviewing, and updating departmental policies and procedures
• Advising and ensuring the implementation of corrective action plans
• Developing and providing BCBSA or Affiliated companies training

The posting range for this position is: $85,126.00-$117,521.58

Qualifications:

• Education: Required Bachelor's Degree or equivalent work experience
• Experience: 4+ Years experience auditing government regulations Required

Knowledge, Skills, and Abilities:

• Knowledge of claims processing
• Knowledge of financial processing
• Audit Report writing
• Effective writing skills
• Effective communication skills
• Presentation skills
• Knowledge of Microsoft Office Suite

Certifications & Licenses:

• Preferred: Certified Internal Auditor (CIA) - Institute of Internal Auditor

Extra Posting Information:

• Four or more years experience auditing government regulations
• Experience auditing Blue Cross Blue Shield Plans

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.