Performance Audit Senior Consultant

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

Job summary

A leading health insurance organization in North Carolina is seeking an experienced professional to manage operational audits and ensure effective customer interactions. The role includes leading audit programs, analyzing performance, and providing training and support to Plan staff. Candidates must have a Bachelor's degree and over 5 years of related experience. This position offers a competitive salary ranging from $92,788 to $130,326 annually, with the possibility of remote work.

Qualifications

• Required Bachelor's Degree or equivalent experience.
• 5+ years of related work experience required.

Responsibilities

• Execute Operational Audit Programs and validate claims processing.
• Lead cross-functional meetings with Plan stakeholders.
• Develop and administer various audit initiatives.

Skills

Adaptability to changing priorities

Proficiency in Microsoft Office

Research and analytical skills

Presentation skills

Communication skills

Education

Bachelor's Degree in a business related discipline

Job description

Overview

This role ensures Plans\' operations handle customer interactions accurately and promptly, leaving a positive brand impression. Responsibilities include executing audit programs and validating reported results, presenting updates and recommendations at various events, contributing to strategic planning by developing materials, presentations, and documentation, creating and improving standard operating procedures for departmental functions, interacting extensively with Plan staff at all levels, requiring diplomacy in difficult conversations, and influencing local and national Plan operations.

Responsibilities

• Responsible for overall Plan execution of the Operational Audit Programs, including 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 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 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.

#LI-Remote

Posting range: $92,788.00-$130,326.32