Quality Audit Analyst

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

Benefits offered by this job

Hybrid work arrangement

In-office 3 days per week in Helena,MT

Job summary

HCSC is seeking a Quality Audit Analyst in Helena, MT to plan and conduct detailed audits of claims, inquiries, and memberships, ensuring internal controls and Model Audit Rule compliance. You will review transactions and data across Blue Chip systems to verify timely, accurate processing according to standard processes.

The role requires a Bachelor’s degree and 2+ years of health insurance auditing experience or 6+ years in the industry, with strong analytical and communication skills.

Qualifications

• Bachelor's 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 Blue Chip processing systems (i.e., BlueSTAR, CFE), contract administration, and medical terminology.
• Strong analytical, research and communication skills.

Responsibilities

• Plan and conduct detailed audits related to quality and performance.
• Review business transactions such as claims, inquiries or membership to ensure adherence to internal controls and Model Audit Rule requirements.
• Ensure processing is timely, accurate, and complete in appropriate systems.
• Communicate findings clearly and prepare documentation for management.

Skills

Auditing

Analytical skills

Verbal communication

Organizational skills

PC proficiency

Education

Bachelor's degree

Tools

BlueSTAR

CFE

EPPS

NICE

Live Meeting/WebEx

Lotus Notes

Excel

Word

PowerPoint

Job description

## Quality Audit AnalystApply: Flex: MT - Helena: Full time: Posted Today: R0055844At 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-HybridThis 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.The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.## 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 - $92,800.00Exact compensation may vary based on skills, experience, and location.