Audit Analyst

Position Purpose:

Responsible for performing in-depth review of resolved claims, enrollment, and customer inquiry processing to ensure compliance with the three audit programs: Member Touchpoints Measure (MTM), Federal Employee Program (FEP), and Licensee Desk Level Audit (LDLA). Reports results to the BlueCross BlueShield Association (BCBSA) and FEP Director's Office (DO), and according to LDLA guidelines and procedures.

Location:

This position has the opportunity to be on a 3 days W@Hand 2 Days in office work schedule, in Columbia, SC. Please note this is subject to change based on employee performance and/or business need.

What You'll Do:

• MTM and FEP programs: Performs timely operational and service assessments of all branded claims, enrollment, and customer service processing functions. Collects and reports performance data quarterly externally to the BCBSA and FEP DO. LDLA program: Conducts audits of Host/PAR samples to maintain corrective issues and reassure accounts of the accuracy of national account administration. Reports results externally to BCBSA on a semi-annual basis.

• Verifies audit sample populations, dollar populations, performance, and calculating accuracy rate using weighted formulas.

• Performs focused internal line of business audits.

• Creates and distributes audit reports to management.

To Qualify for This Position, You'll Need the Following

Required Education:

• Bachelor's

Degree Equivalency:

• Associate's degree plus 2 years of job-related work experience for a total of 4 years required experience. (Please see required work experience below).

OR

• 6 years of job-related work experience. (Please see required work experience below).

Required Work Experience:

• 2 years claims processing or audit experience in a healthcare environment.

Required Skills and Abilities:

• Strong interpersonal skills.

• Ability to work professionally with persons at all levels.

• Ability to maintain effective working relationships.

• Ability to communicate clearly and effectively in oral and written form.

• Ability to handle sensitive matters on a confidential basis.

• Understanding of claims adjudication on AMMS or similar system.

• Ability to interpret contractual language.

• Strong research, planning, and organizational skills.

• Ability to schedule and prioritize in order to accomplish audits timely.

• Knowledge of auditing methodology.

Required Software and Tools:

• Microsoft Office.

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage

• 401K retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Tuition Assistance

• Service Recognition

• Employee Assistance

• Discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the required qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information.

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.