Claims Audit Analyst

BCBS Global Solutions; King of Prussia (PA); Hybrid; USD 65.000 - 90.000; Vollzeit

Benefits dieser Stelle

Hybrid work model

Telemedicine services

Paid parental leave

Wellness programs

Tuition reimbursement

401(k) with company match

Pet insurance options

Identity theft protection

Zusammenfassung

BCBS Global Solutions is seeking a Claims Audit Analyst to audit health insurance claims for quality and accuracy, turning findings into actionable insights. You’ll maintain audit schedules, track results, and prepare reports for leadership while collaborating with cross-functional teams to drive corrective actions and process improvements.

Ideal candidates have 5+ years’ experience in claims examination, knowledge of CPT/ICD-10, and strong communication skills, with proficiency in Microsoft

Qualifikationen

• 5+ years of experience in health insurance claims examination or a related healthcare operations role.
• Knowledge of CPT, ICD-10 and healthcare reimbursement concepts.
• Ability to turn data into insights and present findings clearly.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Office and claims administration systems.

Aufgaben

• Audit claims for quality and accuracy in line with policies, client requirements and regulatory guidelines.
• Maintain audit schedules and complete required audit volumes within timelines.
• Track audit findings and prepare monthly statistics and quality reports for leadership.
• Analyze results to spot trends, recurring issues, training opportunities and risks.
• Collaborate with operational teams to clarify findings and support corrective actions.

Kenntnisse

Attention to detail

Claims auditing

Data interpretation

Communication

Microsoft Office

Ausbildung

High school diploma or equivalent

Tools

Claims administration systems

Jobbeschreibung

Who we are.

At Blue Cross Blue Shield Global Solutions℠ (BCBS Global Solutions℠), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that's simple, efficient, and human.

Whether our customers live, work, travel, or study abroad, we give them the confidence and peace of mind to say "yes" to new possibilities.

What we’re looking for in our Claims Audit Analyst:

You have an eye for detail and enjoy digging into complex claims to understand what’s working, what isn’t and where we can improve. You’re comfortable making objective decisions, spotting patterns and turning what you find into practical insights that help strengthen claims quality.

You’re someone who:

• Takes pride in exceptional accuracy and getting the details right
• Enjoys spotting trends, inconsistencies and opportunities to improve
• Uses sound judgment and stays objective when reviewing others’ work
• Can turn data and audit findings into clear, meaningful insights
• Communicates findings clearly and constructively
• Enjoys collaborating across teams to improve quality and processes

Here’s the work you'll be doing to support claims quality and audit operations:

Audit claims for quality and accuracy

• Review claims to ensure they’re processed accurately, consistently and in line with company policies, client requirements and regulatory guidelines
• Conduct routine and random audits, including reviews of claims that exceed processor payment authority levels
• Support auditing requirements across Classic, BCBS Global Core, FEP and other assigned business lines
• Maintain audit schedules and complete required audit volumes within established timeframes

Turn findings into useful insights

• Track and document audit findings and maintain accurate records
• Analyze results to spot trends, recurring issues, training opportunities and operational risks
• Prepare monthly audit statistics and quality reports for leadership
• Turn findings into practical recommendations that improve quality, consistency and efficiency
• Help leadership understand what the data is telling us and where opportunities exist to improve

Support compliance and continuous improvement

• Support internal and external audit activities, including Association and client audits
• Review surcharge reports, approval queues and other quality-control processes
• Complete high-dollar claim notifications, stop-loss filings and related documentation
• Partner with operational teams to clarify findings and support corrective actions
• Share audit insights and best practices that help strengthen claims accuracy
• Collaborate with leadership to support training and continuous improvement efforts

This might be the right fit for you if...

• You have 5+ years of experience in health insurance claims examination, adjudication or a related healthcare operations role
• You understand medical claims processing, benefit structures and insurance terminology
• You’re familiar with CPT, ICD-10 and healthcare reimbursement concepts
• You’re comfortable interpreting policies, identifying exceptions and documenting your findings
• You’re analytical, organized and able to manage multiple priorities without losing attention to detail
• You communicate clearly, both verbally and in writing
• You’re comfortable using Microsoft Office and working within claims administration systems
• You have a high school diploma or equivalent; additional education or certifications are a plus

Bonus points if you have...

• Claims quality auditing experience
• CPC, CCS or another relevant coding certification
• Experience supporting Federal Employee Program (FEP) audits
• Knowledge of BCBS Association audit requirements
• Experience creating audit reports, scorecards or trend analyses
• Experience presenting findings and recommendations to leadership
• Experience working in a highly regulated healthcare environment

What you’ll get in return:

• Competitive base pay + annual bonus
• Competitive medical plans
• Telemedicine services
• Paid parental leave
• 24/7 employee assistance and wellness support
• Free international healthcare coverage

Other great perks:

• Hybrid work model (office and/or remote)
• Work-abroad arrangements available
• Generous PTO accrual with carry-over options
• 9 paid holidays, plus one floating holiday and one volunteer day
• Tuition reimbursement
• Career development and learning opportunities
• 401(k) with generous company match
• Pet insurance options
• Identity theft and legal coverage
• Ongoing focus on well‑being, including virtual wellness resources and mindfulness events

Please visit the employee benefits page on our website for more information on our benefits and perks that support your overall well‑being.

EOE