Corporate Performance Analyst

Role Description

This position is responsible for the audit functions related to determining and validating Plan performance, as it relates to Membership, Claims and Customer Service activity. This is accomplished through accordance with established policies, internal procedures and BCBSA mandated audit guidelines related to the Federal Employee Program (FEP). The position also provides analysis, reports and feedback as it relates to assigned Performance Guarantee accounts and participates in external client audit requests.

• Audits claims, customer service inquiries, member and group enrollment activities, product builds as well as focus and client audits as assigned.
• Supports IA and SIU with assistance as needed.
• Utilizing internal formatting, maintains adequate documentation to support all audit reviews and outcomes.
• Performs processes for assigned Performance Guarantee accounts to ensure accurate reporting of results.
• Participate in team collaborative efforts to resolve audit issues.
• Utilizes the internal SharePoint Audit Tool to communicate findings and follow up assuring corrective action is taken and documented.

Qualifications

• Research, analytical and problem-solving skills.
• Ability to communicate effectively with diverse audiences both in writing and verbally.
• Ability to address workload to meet numerous deadlines, accommodate and adapt to changing priorities.
• Understanding of the healthcare industry as it relates to Capital Blue Cross.
• Understanding of claims coding and processing including BlueCard and FEP; membership processes at both the group and member level; and customer service processes, also including FEP.
• Familiar with Capital’s various product designs and their coding structures.
• Familiar with Microsoft Office applications, especially Excel, Facets, FEP Direct, and SharePoint.

Requirements

• A minimum of 5 years’ experience in Claims, Membership or Customer Service (or combination of the three); depending on current business needs.
• Audit and/or analytical experience desired.
• High School diploma or GED.

Physical Demands

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must be able to work over 40 hours per week.
• The employee must occasionally lift and/or move up to 5 pounds.
• Must be able to work in excess of 37.50 hours a week when necessary.

Benefits

• Comprehensive benefits package including Medical, Dental & Vision coverage.
• Retirement Plan.
• Generous time off including Paid Time Off, Holidays, and Volunteer time off.
• Incentive Plan.
• Tuition Reimbursement.