Performance Audit Senior Consultant

Blue Cross Blue Shield Association; Massachusetts; Remote; USD 92,000 - 131,000; Full time

Job summary

A leading healthcare organization in Massachusetts is seeking an experienced professional to manage operational audit programs, ensuring accurate customer interactions within the Plans. The ideal candidate will have a Bachelor's degree and over 5 years of relevant experience. Responsibilities include analyzing performance results and leading educational initiatives for stakeholders. This role offers competitive compensation and may allow for remote work.

Qualifications

• 5+ years of related work experience required.

Responsibilities

• Responsible for overall Plan execution of the Operational Audit Programs.
• Analyze performance results and lead cross-functional meetings.
• Lead in the development and administration of various audit initiatives.
• Provide Plans education and support in operational and audit requirements.

Skills

Ability to manage and adapt to multiple, changing priorities

Demonstrated proficiency in the Microsoft Office suite

Demonstrated research and analytical skills

Demonstrated presentation and communication skills

Knowledge of BlueCross Blue Shield and Inter-Plan Programs

Education

Bachelor's Degree in a business related discipline

Job description

Overview

The posting range for this position is: $92,788.00-$130,326.32. The role ensures Plans' operations handle customer interactions accurately and promptly, leaving a positive brand impression. Execute audit programs and validate reported results. Present updates and recommendations at various events. Contribute to strategic planning by developing materials, presentations, and documentation. Create and improve standard operating procedures for departmental functions. Interact extensively with Plan staff at all levels, requiring diplomacy in difficult conversations. Influence local and national Plan operations.

Responsibilities

• Responsible for overall Plan execution of the Operational Audit Programs. This includes auditing Plans' local and inter-Plan claim processing, local customer service processing, and enrollment processing in accordance with applicable program.
• Analyze performance results and lead cross-functional meetings with Plan stakeholders in order to facilitate the development and completion of action plans for each performance program.
• Lead in the development and administration of various audit initiatives/programs that impact internal and external stakeholders.
• Provide Plans education and support by helping them to understand and properly execute operational and audit requirements in both formal and informal settings on a scheduled or ad-hoc basis. This includes providing face-to-face training, webinars, handling the Help Desk, one-on-one meetings, and collaborating with other BCBSA staff.

Qualifications

Education

• Required Bachelor's Degree in a business related discipline or equivalent work experience

Experience

• 5+ Years related work experience Required

Knowledge Skills and Abilities

• Ability to manage and adapt to multiple, changing priorities.
• Demonstrated proficiency in the Microsoft Office suite and Internet technologies.
• Demonstrated research and analytical skills (quantitative and qualitative).
• Demonstrated presentation and communication skills both oral and written.
• Knowledge of BlueCross Blue Shield and Inter-Plan Programs.

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