Auditor, Special Investigations

Blue Cross & Blue Shield of Mississippi; Flowood (MS); In loco; USD 60.000 - 90.000; Tempo pieno

Descrizione del lavoro

A health insurance company in Flowood, Mississippi is seeking an Auditor for Special Investigations. The role involves conducting audits of Network Providers to ensure compliance, and to identify and address issues of fraud, waste, and abuse. The ideal candidate should have a Bachelor's degree in Business or a related health field, along with three years of audit experience, preferably in the healthcare industry. Strong communication and data analysis skills are essential. Comprehensive benefits provided.

Competenze

• Three years of audit experience, preferably with Institutional providers.
• Healthcare experience preferred.
• Experience in data analysis and analytical reporting required.
• Experience in data analysis and analytical reporting is required.
• PC skills include Microsoft Office Suite.
• Effective oral and written communications skills.

Mansioni

• Conduct comprehensive audits of Network Providers for compliance.
• Identify and remediate Provider fraud, waste, and abuse.
• Collaborate with Management and Provider Compliance team.

Conoscenze

Data analysis

Oral communication

Written communication

Microsoft Office Suite

Communication skills

Formazione

Bachelor’s Degree in Business or health-related field

Strumenti

Microsoft Office Suite

Descrizione del lavoro

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Healthy Careers Start Here

At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast‑paced atmosphere. Our "be healthy" culture promotes health and wellness at all levels of the Company, and we provide our employees with the time, tools and resources to commit to a healthy lifestyle.

Responsibilities

The incumbent is responsible for conducting comprehensive audits of Network Providers (Institutional, Professionals and Allied) for compliance and to identify and remediate Provider fraud, waste and/or abuse. The incumbent collaborates with Management and the Provider Compliance team to implement proactive Provider billing monitoring designed to identify potential fraud, waste and abuse. The incumbent is responsible for collaborating with the Clinical Quality and Claims Operations Business Areas to identify and address fraud, waste and abuse and implement controls to address identified fraud, waste and abuse and quality issues.

Job‑Specific Requirements

• A Bachelor’s Degree in Business or other health related field is required.
• Three (3) years audit experience required with experience in auditing Institutional providers or other related provider auditing is preferred.
• Healthcare experience preferred.
• Experience in interpretation of data analysis and analytical reporting is required.
• PC skills required to include the Microsoft Office Suite.
• Effective oral and written communications skills.

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers.