Hybrid Quality Audit Analyst – Health Insurance

Health Care Service Corp.; Helena (MT); Hybrid; USD 42,000 - 93,000; Full time

Job summary

Health Care Service Corp. (HCSC) seeks an auditor to plan and conduct detailed audits of claims, inquiries, and memberships within health insurance operations. You will ensure internal controls and Model Audit Rule compliance and verify timely, accurate processing in the appropriate systems.

The role requires strong analytical skills, health insurance audit experience, and proficiency with standard office software. Hybrid work with in-office Helena, MT.

Qualifications

• Bachelor degree and 2 years experience auditing claims, inquiry or membership within the health insurance industry OR 6 years experience auditing claims, inquiry or membership within the health insurance industry.
• Knowledge of the various Blue Chip processing systems (i.e., BlueSTAR, CFE, etc.) contract administration, and medical terminology.
• Analytical and research skills.
• Clear and concise written and verbal communication skills.
• Organizational and multi-tasking skills to manage daily work load and meet aggressive deadlines and timetables.
• Knowledge of state contract provisions.
• Knowledge with sold case materials, departmental documents.
• PC proficiency to include Word, Excel, PowerPoint, EPPS, NICE, Live Meeting/WebEx and Lotus Notes.
• Experience meeting deadlines.

Responsibilities

• Plan and conduct detailed audits, analyzing programs related to quality and performance.
• Review business transactions such as claims, inquiry or membership to ensure compliance with internal controls and Model Audit Rule requirements.
• Ensure processing is performed timely, accurately, and completely in the appropriate systems.

Tools

Word

Excel

PowerPoint

EPPS

NICE

Live Meeting/WebEx

Lotus Notes

Job description

Health Care Service Corp. (HCSC) seeks an auditor to plan and conduct detailed audits of claims, inquiries, and memberships within health insurance operations. You will ensure internal controls and Model Audit Rule compliance and verify timely, accurate processing in the appropriate systems.

The role requires strong analytical skills, health insurance audit experience, and proficiency with standard office software. Hybrid work with in-office Helena, MT.