Senior Healthcare Claims Audit Specialist

Independence Blue Cross; Philadelphia (Philadelphia County); On-site; USD 85,000 - 110,000; Full time

Job summary

Independence Blue Cross is seeking a Sr. Audit Analyst to lead external audit timelines and improve audit practices across the organization.

The role focuses on healthcare claims audits and coordination with multiple departments to ensure accurate, timely responses and documentation. The incumbent will review and modify internal responses for external audiences, maintain audit documentation, and monitor systemic issues while serving as a primary information resource for audit requirements and

Qualifications

• BA/BS in Business Administration, Accounting, or related discipline, or equivalent knowledge by experience.
• Five (5) or more years of healthcare claims audit or related experience.
• Extensive knowledge of audit procedures and practices for external audits.
• Familiarity with MTM, LDLA, and MSP guidelines.
• Knowledge of ITS and OSCAR for eligibility, enrollment and claim processing.
• Working knowledge of benefits coding and HMO/PPO product types.
• Knowledge of pharmacy services.

Responsibilities

• Ensure the meeting of the timeline for external audits.
• Address the most problematic functions with external audits to ensure timely, complete execution.
• Review internal responses from departments for accuracy and completeness.
• Modify responses for appropriate audience (internal/external).
• 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.

Skills

Audit procedures

Healthcare audits

MTM/LDLA/MSP guidelines

Interplan Teleprocessing System ITS

OSCAR eligibility system

Benefits coding knowledge

Pharmacy services knowledge

Customer service trust

Education

BA/BS in Business Administration or Accounting

Tools

ITS (Interplan Teleprocessing System)

OSCAR system

Job description

Independence Blue Cross is seeking a Sr. Audit Analyst to lead external audit timelines and improve audit practices across the organization.

The role focuses on healthcare claims audits and coordination with multiple departments to ensure accurate, timely responses and documentation. The incumbent will review and modify internal responses for external audiences, maintain audit documentation, and monitor systemic issues while serving as a primary information resource for audit requirements and