Performance Analyst
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Job Description
Performance Analyst responsible for FEP Plan performance audits and data validation. Analyzing claims and customer service inquiries; supporting audit processes within a healthcare organization.
Responsibilities:
- Audits FEP claims, customer service inquiries, member and group enrollment activities in accordance with Plan Incentive Program (PIP) guidelines
- Completing Performance Guarantee audits
- Supports IA and SIU with assistance as needed
- Utilizing internal formatting, maintains adequate documentation to support all audit reviews and outcomes
- Providing this material to the appropriate Performance Analyst for internal and BCBSA report compilation
- Participate in team collaborative efforts to resolve audit issues
- Utilizes the internal SharePoint Audit tool to communicate findings and follow up assuring corrective action is taken and documented
Requirements:
- A minimum of 5 years' experience in Claims, Membership or Customer Service
- Knowledge of FEP required
- Audit and/or analytical experience required
- Understanding of the healthcare industry as it relates to BCBSA
- Understanding of claims coding and processing including BlueCard, ITS and FEP
- Familiar with FEPDirect and Microsoft Office applications especially Excel
- High School diploma or GED
Benefits:
- Medical, Dental & Vision coverage
- Retirement Plan
- Generous time off including Paid Time Off
- Holidays
- Volunteer time off
- Incentive Plan
- Tuition Reimbursement
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