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Internal Auditor, Associate

Company: Blue Shield of California
Location: Oakland
Posted on: June 6, 2021

Job Description:

Job Summary

This position will be responsible for performing compliance and contractual audits such as MTM, FEP, Performance Guarantee, and LDLA. The auditor will assure adherence to established specifications, quality standards, contractual agreements, and Blue Cross Blue Shield Association guidelines. The auditor conducts comprehensive quality review to identify performance deficiencies. This position can be based in Lodi, El Dorado Hills, or Redding, CA.

  • Audit focus is in multiple areas, including Claims, Customer Service, Enrollments, etc.
  • Responsible for performing transactional audits for accuracy and compliance with Blue Shield guidelines, measurements and/or contractual agreements
  • Identifies and accurately documents findings
  • Drafts communications to Operations regarding findings
  • Researches and responds to rebuttals
  • Participates in trending, corrective and preventive action planning & implementation
  • Communicates issues to Manager immediately, provides potential solutions
  • Identifies and resolves most problems independently, consults on complex issues when necessary

Knowledge and Experience

  • Typically requires a minimum of 2-4 years of related experience successfully demonstrating increasingly complex work
  • Understands Financial Accounting and Finance Concepts,
  • Knowledge and experience in multiple Blue Shield Operational areas, such as: Claims processing, I&B Enrollments, Customer Service
  • Audit experience strongly desired
  • Strong organizational skills, attention to detail, analytical skills and strong reading comprehension
  • Strong written and verbal communication skills
  • Ability to objectively review and interpret standards, procedural documentation and contract and legal verbiage
  • Ability to access information and organizational references necessary to complete tasks
  • Strong PC skills, including MS Office

Additional Information

  • About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!
  • Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

  • EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
  • Requisition ID: 21001O8
  • Posting Date: May 24, 2021
  • Schedule: Full-time

Keywords: Blue Shield of California, Oakland , Internal Auditor, Associate, Other , Oakland, California

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