Senior Claims Audit Analyst

Sr. Audit Analyst Responsibilities

• Ensure the meeting of the timeline for external audits.
• Address the most problematic and difficult functions associated with the External Audit function to ensure timely and complete execution of external audits in accordance with sound audit practices and regulations.
• Review all internal responses from departments for accuracy and completeness.
• Modify responses to address properly the audience for an internal or external party.
• 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.

Qualifications/Skills

• BA/BS in Business Administration, Accounting, or related discipline, or equivalent knowledge acquired by on-the-job training and experience.
• Five (5) or more years of healthcare claims audit or progressively more responsible experience in Customer Service, Enrollment, Claims, Provider Services, Medicare, Quality, or related administrative activities.
• Extensive Knowledge of audit procedures, requirements, and practices related to these audits.
• Have familiarity and Acquire Working Knowledge Working with BCBSA guidelines for Member Touchpoint Measures (MTM), BCBSA Line Desk Level Audit (LDLA), and Multi-State Plan (MSP).
• Extensive Knowledge of all key operating systems such as Interplan Teleprocessing System (ITS) and OSCAR for eligibility, customer service, enrollment, and claim processing issues.
• Working Knowledge of benefits coding, and package types for the HMO and PPO products.
• Working Knowledge of pharmacy services.

About the Role

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.

Benefits

Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

Equal Employment Opportunity

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.