Senior Audit Analyst at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve.

Senior Audit Analyst Responsibilities:

• Serve in a senior role to ensure the timely completion of operational (and some financial) external audit projects in accordance with agreed-upon audit criteria, sound audit practices, and the IBC Audit Policy.


• Develop strategies and discuss with management approaches to resolve audit issues.


• Ensure all assigned deliverables are completed with the written audit expectations for the external audit project.


• Address all confirmed audit issues identified from an Operational Audit project with the internal IBC stakeholder departments to ensure the root cause has been properly identified, verify the implementation of remediation steps, and verify the completion of any financial/claim impacts.


• Serve as point of contact and knowledge expert for external auditors and internal stakeholder departments.


• Review all internal responses to potential errors/issues from departments for accuracy and completeness.


• Evaluate responses and modify as needed to properly address an internal or external audience.


• Prepare and quality review all audit supporting documentation before issuance. 


• Monitor the resolution of confirmed manual and systemic issues/errors.


• Serve as an information resource to Audit and client management regarding audit requirements and processes.          


• Train and develop new audit analysts.

Qualifications:

• B.S. Degree with 3 or more years of knowledge of healthcare operational auditing or equivalent quality analytical experience of health care products.


• Experienced knowledge in the utilization of operational audit procedures or quality review analysis experience to complete root cause analysis, verify implemented controls and resolutions to confirmed audit findings.


• General understanding of healthcare claim adjudication, provider pricing/contracting, and account benefit set-up for healthcare products.


• Working knowledge of medical healthcare benefits/products.


• Working knowledge of pharmacy benefits/products is preferred but not required.


• Preferred but not required working knowledge of federal regulations regarding the Federal Employee Program (FEP)


• Preferred but not required working knowledge of the BCBSA Member Touchpoint Measures Program (MTM), BCBSA Line Desk Level Audit (LDLA), Interplan Teleprocessing System (ITS), Health Rules, and OSCAR claim adjudication systems is preferred but not required.


• Possess strong oral skills for communications with various levels of management and strong written skills for drafting responses to audit findings. 

Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

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 that is compatible with the free Microsoft Authenticator app.