Senior SIU Auditor: Healthcare Fraud & Coding

Premera Blue Cross; Mountlake Terrace (WA); Hybrid; USD 70,000 - 118,000; Full time

Job summary

Premera Blue Cross is seeking an experienced Senior SIU Auditor to conduct audits of medical claims, coding, and documentation. You will lead fraud prevention efforts and support corrective actions with data-driven insights.

The role requires CPC and AHFI credentials, 5+ years in healthcare auditing, and proficiency with SQL and analytics tools. This position offers a hybrid work environment and opportunities to mentor junior staff.

Qualifications

• Bachelor’s degree or equivalent in a related field.
• 5+ years in healthcare coding, auditing, SIU, compliance investigation, claims analysis, appeals, or related experience.
• Active CPC and AHFI credentials are required.
• Additional credentials such as CPC-P, CPMA, CCS, CFE, or CHC are preferred.
• Experience with SIU case management systems, SQL, Excel, and data analytics/audit tools.

Responsibilities

• Audit and coding review of medical claims, provider billing, coding, and documentation.
• Perform investigative analysis to identify fraud, waste, and abuse; develop prevention strategies.
• Prepare audit findings, overpayment determinations, and documentation for leadership.

Skills

Analytical

Problem-solving

Communication

Presentation skills

Education

Bachelor’s degree or higher

CPC and AHFI credentials

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

Tools

SIU case management systems

SQL

Excel

Data analytics tools

Job description

Premera Blue Cross is seeking an experienced Senior SIU Auditor to conduct audits of medical claims, coding, and documentation. You will lead fraud prevention efforts and support corrective actions with data-driven insights.

The role requires CPC and AHFI credentials, 5+ years in healthcare auditing, and proficiency with SQL and analytics tools. This position offers a hybrid work environment and opportunities to mentor junior staff.