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This role is responsible for monitoring, analyzing, and auditing financial transactions of high complexity, and providing a leadership role. The role also evaluates compliance with regulations, develops corrective action plans, and delivers training to BCBSA and Plans. Additionally, the role involves acting as a resource and consultant on audit activities, developing programs, policies, and procedures to prevent abuse, and leading and supporting projects. The role frequently interacts with staff and management at varying levels within BCBSA, Plans, and a large banking institution.

• Monitor, Analyze, and Evaluate Financial Transactions: Monitor, analyze, and evaluate assigned financial/accounting transactions and other financial data for accuracy, propriety, and compliance with policy requirements. Document and summarize activities and results in analyses and reports to department management.
• Lead Financial Audits/Reviews: Lead approximately three to five financial audits/reviews per year (via desk or on-site) to determine the accuracy and propriety of Plans recorded financial transactions/reports and assess compliance with pertinent Policies. Supervise and train team members assigned to support these audits.
• Evaluate Compliance and Develop Corrective Action Plans: Evaluate the level of compliance with applicable federal regulations, contractual requirements, and procedures at BCBSA and Plans. Maintain the BCBSA compliance plan and serve as the main point of contact for BCBSA and Plans financial and claims audits. Develop corrective action plans as needed.
• Serve as Subject Matter Expert and Provide Training: Serve as subject matter expert for BCBSA financial policies and procedures regarding the audit process; instruct audit flow facilitation; analyze and assess audit trends, best practices, and risk; and develop an overall and effective audit program. Develop and present training to BCBSA and Plans as it relates to all types of audits.
• Evaluate and Recommend Billing Rates: Evaluate Plan inter-Plan billing rate requests of high complexity levels and recommend rates to be approved to ensure billings/reimbursements between Plans are valid and for proper amounts.
• Perform Complex Contract Administration Activities: Perform more complex activities relating to administration of the contract with a large banking institution and provide guidance to team members on their assignments. Ensure that BCBSA's transaction billings to Plans are correct and that the various transaction activity reports provided to the Plans meet their internal needs.

The posting range for this position is:

89,000.00 - 129,050.00

Qualifications:
Education

• Required Bachelor's Degree in accounting, business, finance, or related field; or equivalent work experience

Experience

• Required 5+ Years related work experience, including health insurance accounting, internal/financial auditing, general accounting, financial reporting, and project management

Knowledge Skills and Abilities

• Effective written and verbal communication skills.
• Demonstrated ability to build relationships with key resource people, whether internal or external.
• Ability to train less experienced staff.
• Advanced analytical skills and ability to frame issues and develop solutions.
• Ability to work independently and manage time effectively.
• Effective presentation skills and ability to adapt to changing priorities.
• Intermediate knowledge of auditing, finance, and claims operations.
• Advanced negotiation, analytical, and problem-solving skills.
• Effective project management, interpersonal, and organizational skills.
• Ability to develop and maintain business relationships and create strategies that support initiatives.

Certifications & Licenses

• Preferred: Certified Public Accountant (CPA) - Various
• Extra Posting Information:

  Minimum of five years of related work experience, including health insurance accounting, internal/financial auditing, general accounting, financial reporting, and project management. Experience with BCBS Inter-Plan Programs and proficiency with Microsoft Office Suite.

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