Quality Audit Analyst

HCSC; Helena (MT); Hybrid; USD 42,000 - 93,000; Full time

Job summary

HCSC in Helena, MT is seeking an auditor responsible for planning and conducting detailed audits related to quality and performance. You will review claims, inquiries, and membership to ensure compliance with internal controls and M.A.R.

and verify timely, accurate processing in core systems. The role requires a bachelor degree with 2 years of auditing claims within health insurance or 6 years of related experience.

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.
• Preferred Job Qualifications: Quality audit experience
• Knowledge of health insurance products.

Responsibilities

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

Skills

Analytical skills

Research skills

Communication skills

Organizational skills

PC proficiency

Education

Bachelor's degree

Tools

BlueSTAR

CFE

EPPS

NICE

Live Meeting/WebEx

Lotus Notes

Job description

Flex

MT - Helena

Full time

R0055844

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This Position Is Responsible For Planning And Conducting Detailed Audits, Analyzing Programs, Related To Quality And Performance. Review Business Transactions Such As Claims, Inquiry Or Membership, Processes Etc To Assure That: A) Internal Controls And Model Audit Rule Requirements Are Adhered To, And B) Processing Is Performed Timely, Accurately, And Completely In The Appropriate Systems In Accordance With Standard Business Processes.

Job Requirements

• 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.
• Preferred Job Qualifications:
• Quality audit experience
• Knowledge of health insurance products.

#LI-Hybrid

This role is 3 in-office and 2 days remote at our Helena, MT location

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards .

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$41,700.00 - $92,800.00

Exact compensation may vary based on skills, experience, and location.

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.

Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas,

Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association

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