Claims Quality & Audit Analyst — Hybrid/Remote

BCBS Global Solutions; King of Prussia (PA); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Hybrid work model

Telemedicine services

Paid parental leave

Wellness programs

Tuition reimbursement

401(k) with company match

Pet insurance options

Identity theft protection

Job summary

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

Qualifications

• 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.

Responsibilities

• 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.

Skills

Attention to detail

Claims auditing

Data interpretation

Communication

Microsoft Office

Education

High school diploma or equivalent

Tools

Claims administration systems

Job description

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