Quality Audit Analyst - Hybrid (Health Insurance Claims)

HCSC; Helena (MT); Hybride; USD 42 000 - 93 000; Plein temps

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Analytical skills

Research skills

Communication skills

Organizational skills

PC proficiency

Formation

Bachelor's degree

Outils

BlueSTAR

CFE

EPPS

NICE

Live Meeting/WebEx

Lotus Notes

Description du poste

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.