This job was posted by https://idahoworks.gov : For more information, please see: https://idahoworks.gov/jobs/2203512 Our Performance Auditor perform 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) Management.

What we are looking for:

• Performance Auditor I: 3 years\' medical claims processing, insurance claim billing, claim auditing, or quality assurance experience

Your day may look like:

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

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.