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Senior Consultant, Performance Audit

Expired Job

Blue Cross And Blue Shield Association Chicago , IL 60602

Posted 2 weeks ago

Overview

The Board-mandated performance programs ensure that Plans' operations are completing and resolving customer-facing interactions accurately, timely, and to customers' satisfaction in order to leave a positive impression of the Brands. The performance auditor ensures that the audit programs are executed by Plans in accordance with program requirements and that the Plans' reported performance results are valid.

Responsibilities

Responsibilities include but are not limited to:

  • Responsible for overall Plan execution of the MTM Program, the LDLA Host Program, and the LDLA Home Program. This includes auditing Plans' local and inter-Plan claim processing, local customer service processing, and enrollment processing in accordance with applicable program requirements.

  • 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 including the MTM Program, the LDLA Host Program, and the LDLA Home Program.

  • Lead in the development and administration of various audit initiatives/programs that impact internal and external stakeholders, including: SOC2, High-Dollar Prepayment Review, Provider Audit Recoupments, MSP CQA, Provider Data Quality, technical development of the LDLA application and claim extract process.

  • Provide Plans education and support by helping them to understand and properly execute operational and audit requirements for the MTM Program, the LDLA Host Program, and the LDLA Home Program 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

Required Basic Qualifications:

  • Bachelor's degree in a business related discipline or 4 years related work experience.

  • Demonstrated research and analytical skills (quantitative and qualitative).

  • Demonstrated presentation and communication skills both oral and written.

  • Experience in managing and adapting to multiple, changing priorities.

  • Demonstrated proficiency in the Microsoft Office suite and Internet technologies.

Preferred Basic Qualifications:

  • Bachelor's degree in a business related discipline and 4 years related work experience.

  • Work experience with BlueCross Blue Shield and Inter-Plan Programs.

  • Demonstrated research and analytical skills (quantitative and qualitative).

  • Demonstrated presentation and communication skills both oral and written.

  • Experience in managing and adapting to multiple, changing priorities.

  • Demonstrated proficiency in the Microsoft Office suite and Internet technologies.

Equal Opportunity Employer

Blue Cross Blue Shield Association is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, disability, veteran status, genetic information or any other legally protected characteristics.


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Senior Consultant, Performance Audit

Expired Job

Blue Cross And Blue Shield Association