Blue Cross And Blue Shield

Internal Reference Number: R1050080 Summary Responsible for the coordination and completion of the audit reviews, reviewing audit work papers and reports completed by department staff, distributing reports to management, coordinating auditor's assignments, mentoring and coaching department staff, and assisting the department manager with the direction of the workflow of various risk management activities and special projects.Description This a part time position working approximately 20-30 hours weekly. This is a remote position and the task can be performed at any location. What You'll Do: Independently and objectively helps plan and execute audits in accordance with professional auditing standards. Performs or supports audits focused primarily on operational controls, asset safeguarding, and compliance with procedures, laws, and regulations. Functions as in-charge auditor of the most complex audit reviews and/or cost reports. May conduct reviews of account reconciliations...

Internal Reference Number: R1049782 Summary Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service.Description Position Purpose: Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service. Logistics:PACE Underwriters-one of BlueCross BlueShield's South Carolina subsidiary companies. Location:This position is full-time (40 hours/week) Monday-Friday from8:00am-4:30pm CSTand will befully remote or hybridif based near our Dallas office. What You'll Do: Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier. Recognize cost mitigation opportunities. Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits. Initiate claims investigations and vendor referrals. Interpret plan language, and identify...

Internal Reference Number: R1049924 Summary Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources.Description The Auditor position is a full-time (40 hours) remote position with a flexible schedule that can include working 4 days per week. This position has the ability to work from any US location. What You'll Do: Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corporation including evaluation of internal controls. Identifies, documents, and evaluates business risks. Develops written audit programs. Conducts testing and analysis of existing controls to determine adequacy and effectiveness. Prepares written work papers to document testing results and conclusions reached. Documents issues, the causes of those issues, and their...