Blue Cross Blue Shield Association Looking for Senior Claim Ops Auditor FEP at Washington, DC  Full Time

Coordinate all Office of the Inspector General (OIG) Global and Plan Specifics as well as the audit resolutions processes to close the final reports issued. Coordinate and track responses to all Plan and Vendor government audit findings working with 59 operating Plans and staff and management as required. Develop, maintain and monitor audit resolution tracking reports, spreadsheets and conduct appropriate analysis to resolve audit issues timely. Serves as the primary contact for the OIG audit team and the OPM Contracting Office Audit Resolution staff to assist in negotiating resolution of audit issues on behalf of Plans and BCBSA. Leads the claims overpayment risk assessment and execution of the audit program and executes complicated and complex testing and reporting activities.

Responsibilities include but are not limited to: Coordinate OPM OIG Audits

• Resolve OPM OIG Final Audits and ensure that recommendations are fully implemented.
• Participate in Plan Control Performance Reviews (either complete an area within the audit program or review staff work papers for completed areas of the Program)
• Complete FEP Compliance activities related to auditing the Annual Accounting Statement, the Fraud Waste and Abuse process and any other compliance activities needed.
• Coordinate and Resolve OPM OIG Global Audits
• Provide Plan training.
• Other activities as requested.

Required Education, Certifications and Experience

• Bachelor’s degree or equivalent work experience

• Experience auditing government regulations

• Knowledge of claims processing

• Knowledge of financial processing

• Audit Report writing.

• Effective writing skills

• Effective communication skills

Preferred Education, Certifications and Experience

• Experience auditing Blue Cross Blue Shield Plans

• Certified Public Accountant

• Certified Internal Auditor

People Management – No

Blue Cross Blue Shield Association is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, disability, veteran status, genetic information or any other legally protected characteristics.