A career with the Blue Cross Blue Shield Association allows you to be part of the organization that supports Blue Cross and Blue Shield companies nationwide. We seek to improve health care quality, affordability, and accessibility for all Americans, and we want you to join the team! Driven by our North Star, to expand access to high-quality, affordable care for every community we serve, we foster a culture grounded in collaboration, accountability, and continuous improvement. Our people experience is built on meaningful work, competitive total rewards, and opportunities for growth, empowering you to make an impact while thriving both professionally and personally. Text box This role is responsible for the business analytical audits relating to the distribution of the BCBSA incentive programs, leads the development and design of business solutions, and applications that directly support the framework activities related to the BCBSA Audit Program that measures the performance of financial and operations controls. Identifies and drives process and system enhancements to improve efficiencies within the BCBSA Audit Program. Performs systematic data analysis including financial, medical claims, pharmacy claims, and member enrollment/eligibility data ensuring the interpretation of audit findings and development of recommendations and/or strategies to meet BCBSA core quality objectives. Develops and performs complex root-cause analyses, and data analyses to improve quality and efficiency of the core BCBSA Audit Program. Provide leadership and management of the audit activities associated with the BCBSA Incentive program, develops, executes and maintains the automation infrastructure used to ensure the timely and accurate distribution of award payment according to projected schedules. Leads projects to ensure the successful implementation of prepayment controls into the BCBS Claims System to ensure accurate claims' adjudication consistent with government contracts. Provides ongoing technical support to Audit teams and BCBS Plans throughout the life-cycle of all BCBSA or Affiliated companies' audits Contribute and participates on initiatives and projects involving healthcare data and information solutions Serves as liaison and SME working directly with BCBSA or Affiliated companies to ensure business requirements and functional requirements are developed for the successful implementation of system enhancements to resolve audit findings The posting range for this position is: 97,900.00 - 141,925.00 Qualifications: Education Required Bachelor's Degree Business administration with a concentration in management information systems or health care, or equivalent work experience Preferred Master's Degree Experience Required 5+ Years specific formal software/system testing experience within a business environment; within a managed care or health services delivery setting Knowledge Skills and Abilities Proficient use of Microsoft 365, Excel, Visual Basic, and SQL programming language Analytic skills in predictive modeling and risk stratification, including a working knowledge of quantitative analysis, prevalence, ROI, outcome measurements, benchmarks, trends and outliers Data modeling skills with Microsoft Access and development skills using VBA, SQL, forms and reports. Verbal and writing skills Intermediate knowledge of auditing, finance and claims operations. Advanced analytic skills in predictive modeling and risk stratification, including a working knowledge of quantitative analysis, prevalence, ROI, outcome measurements, benchmarks, trends and outliers Expert use of Microsoft 365, Excel, Visual Basic, Tableau, IDEA/Advantage Sweet and SQL programming language Ability to create strategies that support initiatives and translate these into action plans Ability to build consensus for business results in a decentralized decision-making structure Excellent interpersonal and communication skills Ability to translate and present complex business concepts and/or quantitative information in a clear, concise and understandable manner Ability to plan, facilitate and present at meetings and conferences. Ability to interact effectively with senior management both internal and external to the Association Preferred: Demonstrates AI literacy and an understanding of generative AI tools, including appropriate business applications and limitations. Extra Posting Information: Five or more years of specific formal software/system testing experience within a business environment; within a managed care or health services delivery setting Experience in software development and information systems integration; documenting System Requirements, Operational Requirements, Test and Evaluation and User and Administrator Training. Experience in health care or government-contracting environment/ Blues Plan experience #LI-Hybrid The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay. We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Text box NOTICE OF USE OF ARTIFICIAL INTELLIGENCE Blue Cross and Blue Shield Association (“BCBSA”) is committed to ensuring compliance with federal, state, and local laws governing the use of technology in the employment context. BCBSA uses artificial intelligence (“AI”) tools to assist with our recruitment process. All hiring decisions remain subject to human review and oversight. If you are a current employee please apply directly through Workday. Begin your career at Blue Cross Blue Shield Association (BCBSA) by exploring currently opportunities and starting your application. It’s easy! After reviewing our open positions, apply to the roles that meet your requirements and ours too. You can keep track your progress in the selection process and review new postings too. Thanks for interest in joining Team BCBSA! At Blue Cross Blue Shield Association (BCBSA), we are a national association of 33 independent, community-based and locally operated Blue Cross Blue Shield companies and we are driven by purpose. Join the team who supports the nation's largest healthcare network, providing coverage to nearly one in three Americans as we relentlessly pursue affordable healthcare and ensure peace of mind for the people we serve. Be part of our storied history of innovation as we advance well-being and health equity. Experience a culture that is built on our core values, connection, work-life flexibility, well-being, and a commitment to our community. If you thrive at a company that values inclusivity, accountability, courage, teamwork, and respect, we're glad you found us!

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