Audit Analytics Senior Consultant

A career with the Blue Cross Blue Shield Association allows you to be part of the organization that supports Blue Cross and Blue Shield companies nationwide. We seek to improve health care quality, affordability, and accessibility for all Americans, and we want you to join the team!

Driven by our North Star, to expand access to high-quality, affordable care for every community we serve, we foster a culture grounded in collaboration, accountability, and continuous improvement. Our people experience is built on meaningful work, competitive total rewards, and opportunities for growth, empowering you to make an impact while thriving both professionally and personally.

Text box

This role is responsible for the business analytical audits relating to the distribution of the BCBSA incentive programs, leads the development and design of business solutions, and applications that directly support the framework activities related to the BCBSA Audit Program that measures the performance of financial and operations controls. Identifies and drives process and system enhancements to improve efficiencies within the BCBSA Audit Program. Performs systematic data analysis including financial, medical claims, pharmacy claims, and member enrollment/eligibility data ensuring the interpretation of audit findings and development of recommendations and/or strategies to meet BCBSA core quality objectives. Develops and performs complex root-cause analyses, and data analyses to improve quality and efficiency of the core BCBSA Audit Program.

• Provide leadership and management of the audit activities associated with the BCBSA Incentive program, develops, executes and maintains the automation infrastructure used to ensure the timely and accurate distribution of award payment according to projected schedules.
• Leads projects to ensure the successful implementation of prepayment controls into the BCBS Claims System to ensure accurate claims' adjudication consistent with government contracts.
• Provides ongoing technical support to Audit teams and BCBS Plans throughout the life-cycle of all BCBSA or Affiliated companies' audits
  Contribute and participates on initiatives and projects involving healthcare data and information solutions
• Serves as liaison and SME working directly with BCBSA or Affiliated companies to ensure business requirements and functional requirements are developed for the successful implementation of system enhancements to resolve audit findings

The posting range for this position is:

97,900.00 - 141,925.00

Qualifications:

Education

• Required Bachelor's Degree Business administration with a concentration in management information systems or health care, or equivalent work experience
• Preferred Master's Degree

Experience

• Required 5+ Years specific formal software/system testing experience within a business environment; within a managed care or health services delivery setting

Knowledge Skills and Abilities

• Proficient use of Microsoft 365, Excel, Visual Basic, and SQL programming language
• Analytic skills in predictive modeling and risk stratification, including a working knowledge of quantitative analysis, prevalence, ROI, outcome measurements, benchmarks, trends and outliers
• Data modeling skills with Microsoft Access and development skills using VBA, SQL, forms and reports.
• Verbal and writing skills
• Intermediate knowledge of auditing, finance and claims operations.
• Advanced analytic skills in predictive modeling and risk stratification, including a working knowledge of quantitative analysis, prevalence, ROI, outcome measurements, benchmarks, trends and outliers
• Expert use of Microsoft 365, Excel, Visual Basic, Tableau, IDEA/Advantage Sweet and SQL programming language
• Ability to create strategies that support initiatives and translate these into action plans
• Ability to build consensus for business results in a decentralized decision-making structure
• Excellent interpersonal and communication skills
• Ability to translate and present complex business concepts and/or quantitative information in a clear, concise and understandable manner
• Ability to plan, facilitate and present at meetings and conferences.
• Ability to interact effectively with senior management both internal and external to the Association
• Preferred: Demonstrates AI literacy and an understanding of generative AI tools, including appropriate business applications and limitations.

Extra Posting Information:

Five or more years of specific formal software/system testing experience within a business environment; within a managed care or health services delivery setting
Experience in software development and information systems integration; documenting System Requirements, Operational Requirements, Test and Evaluation and User and Administrator Training.
Experience in health care or government-contracting environment/ Blues Plan experience

#LI-Hybrid

Text box

NOTICE OF USE OF ARTIFICIAL INTELLIGENCE

Blue Cross and Blue Shield Association (“BCBSA”) is committed to ensuring compliance with federal, state, and local laws governing the use of technology in the employment context. BCBSA uses artificial intelligence (“AI”) tools to assist with our recruitment process. All hiring decisions remain subject to human review and oversight.