Performance Auditor I or II - R3209-6334

Performance Auditor

Blue Cross of Idaho is seeking a Performance Auditor; this role performs operational audits of organizational and functional activities and ensures accurate and timely performance reporting to the Blue Cross Blue Shield Association (BCBSA), Federal Employee Program (FEP), Group Accounts, and Blue Cross of Idaho (BCI) leadership. This position is based in Meridian, Idaho and offers a hybrid work schedule.

Required Experience : 3 / + years' medical claims processing, insurance claim billing, claim auditing, and / or quality assurance experience; preferably includes Facets and FEP Direct experience.

Your day may look like :

• Reviews, evaluates, and verifies the quality of claims adjudication, enrollment processing and customer service transactions against predetermined measures.
• Reviews and / or performs required accuracy and timeliness audits to identify weaknesses, inconsistencies, and inaccuracies in procedures, controls, and integrity of related systems, ensuring complete and accurate documentation.
• Renders nonbiased and ethical decisions ensuring BCBSA and other regulatory agencies guidelines are fully followed.
• Reviews audit findings with both the business unit staff and leadership to ensure audit findings are accurate, fair, and an agreement is achieved.
• Compiles and reports audit results to various internal departments and other outside groups, as required.
• Responsible for validation of sampling methodology and contents of data reports

As of the date of this posting, a good faith estimate of the current pay range is $23.11 to $39.52. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.

We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical / dental / vision / pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

Reasonable accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.