Plan Performance Auditor

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

Candidates applying to this position must live within driving distance of the Omaha, Nebraska metro. This position allows remote flexibility and will have infrequent visits to the office.

This position is responsible for reviewing and analyzing claim, enrollment and inquiry transactions in accordance with the appropriate BCBSNE, BCBSA and FEP guidelines to ensure compliance with applicable regulatory requirements and to ensure the integrity and accuracy of the claim, enrollment and inquiry transaction processing for all lines of business.

What you'll do:

• Perform quality reviews/audits of claim, enrollment and inquiry transactions.

• Research issues identified in reviews by performing additional investigation into applicable documentation, as well as collaborating with operations personnel.

• Communicate/report errors and findings to the appropriate stakeholders.

• Assist with other Plan Performance audit/work as needed.

• Collaborate and serve as a corporate resource to other departments or operational areas.

• Coordinate and organize daily workflow, maintain documentation, attend meetings and other administrative activities.

To be considered for this position, you must have:

• Associate's degree in business or related field and 2 years' experience in the health care industry with claims auditing or claims processing experience

• Knowledge of medical terminology and ICD10/ CPT coding

An equivalent combination of education and experience may be substituted for this requirement.

The ability to meet or exceed the attendance and timeliness requirements of their departments.

The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed 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. Other duties may be assigned.

The strongest candidates for this position will also possess:

• Knowledge of BCBSNE, BlueCard & FEP Operational departments and processing systems

• High attention to detail

• Ability to meet deadlines and time constraints

• Ability to work well with others

• Strong analytical and problem solving skills

• Strong verbal and written communication skills

• Knowledge of auditing procedures and methodologies

• Knowledge of various software applications including, but not limited to Microsoft Word, Excel and Outlook

• Strong research and quality/auditing skills
• Knowledge of CXOne and the CSC process
• Knowledge of PowerBI & SRS reporting
• Knowledge of Office products: specifically Excel and Word

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.