Senior Claims Audit Analyst

Independence Blue Cross, LLC in; Philadelphia (Philadelphia County); On-site; USD 90,000 - 120,000; Full time

Job summary

Independence Blue Cross is seeking a Senior Claims Audit Analyst (Finance) to lead and support audits within a dynamic health plan environment. The role focuses on timely external audits, accuracy of responses, and maintaining audit documentation.

The ideal candidate brings 5+ years in healthcare claims auditing, strong knowledge of MTM/LDLA/MSP guidelines, and experience with ITS and OSCAR systems. This position emphasizes collaboration and regulatory adherence.

Qualifications

• Bachelor-level degree or equivalent experience in business, accounting, or related field.
• 5+ years in healthcare claims audit or related administrative roles.
• Extensive knowledge of audit procedures and practices.
• Familiarity with MTM, LDLA, MSP guidelines per BCBS.
• Experience with ITS and OSCAR systems for eligibility and claims.
• Working knowledge of benefits coding for HMO/PPO and pharmacy services.

Responsibilities

• Ensure meeting timelines for external audits.
• Address difficult functions in the External Audit process to ensure timely audit execution.
• Review internal responses for accuracy and completeness.
• Modify responses for appropriate audiences.
• Prepare audit supporting documentation.
• Perform and develop operational audits and report results.
• Monitor resolution of systemic issues.
• Serve as information resource to Audit and client management on audit requirements and processes.

Skills

Healthcare claim auditing

Audit knowledge

Regulatory compliance

Audience-tailored responses

Education

BA/BS in Business Administration, Accounting, or related discipline

Tools

Interplan Teleprocessing System (ITS)

OSCAR

Job description

Senior Claims Audit Analyst (Finance)

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable wholeperson health.

Sr. Audit Analyst 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.

Qualifications/Skills:

• BA/BS in Business Administration, Accounting, or related discipline, or equivalent knowledge acquired by onthejob 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 MultiState 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.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

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