Senior SIU Auditor - Healthcare Fraud & Coding

Financeroles; Mountlake Terrace (WA); Hybrid; USD 70,000 - 118,000; Full time

Job summary

Premera is seeking a Senior Special Investigative Unit Auditor to oversee audits of medical claims, coding accuracy, and documentation. The role requires strong auditing expertise and the ability to identify fraud, waste, and abuse while guiding corrective actions.

You will manage investigations, collaborate with internal and external partners, and mentor junior staff, ensuring compliance with laws and coding guidance across complex cases.

Qualifications

• Bachelor’s degree or equivalent required.
• Active CPC and AHFI credentials required.
• 5+ years in healthcare coding, auditing, SIU, or related experience.
• Experience with SIU systems, SQL, Excel, and data analytics tools is preferred.

Responsibilities

• Audit retrospective and prospective medical claims, provider billing, coding, and documentation.
• Analyze billing trends to identify suspicious activity and develop fraud prevention strategies.
• Prepare audit findings, overpayments, and investigative documentation for leadership.

Skills

Audit analysis

Healthcare coding

Data analytics

Education

Bachelor’s degree or higher (related field)

CPC credential

AHFI credential

CPC-P/CPMA/CCS/CFE/CHC preferred

Tools

SIU case management systems

SQL

Excel

Job description

Premera is seeking a Senior Special Investigative Unit Auditor to oversee audits of medical claims, coding accuracy, and documentation. The role requires strong auditing expertise and the ability to identify fraud, waste, and abuse while guiding corrective actions.

You will manage investigations, collaborate with internal and external partners, and mentor junior staff, ensuring compliance with laws and coding guidance across complex cases.