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 investigations and audits of potentially abusive/aberrant billing practices and other provider/member issues; identifying and resolving internal issues, tracking the data and potentially coordinating with other areas of the corporation in an effort to improve future outcomes; planning and coordinating the activities of Provider Claims Analyst in support of potential investigations and audits; Utilizing existing database information to identify patterns of abusive/aberrant billing practices by both our provider and member community; and recommending system and internal control enhancements to reduce the potential for adjudication errors.
Required Job Qualifications:
- Bachelor’s degree from an accredited college AND 2 years of general knowledge of claims processing operations and contract and benefit administration, financial control procedures, and statistics OR 6 years of health care investigative experience, including exposure to one or more of the following functional areas: claims processing operations; contract administration; claims coding; and/ or finance and accounting, OR law enforcement experience
- Clear, concise communication skills, and strong analytical and quantitative skills.
- Experience with the Microsoft Office 365 product suite, with an emphasis on Excel and Access.
- Analytical and quantitative skills
Preferred Job Qualifications:
- Knowledge of medical practice patterns.
- Experience working in a financial, accounting, criminal justice, or legal environment.
- Exposure to programming languages, such as SQL.
- Certified Coder
- Investigative Accreditation (AHFI, or CFE)
- Knowledge of Medicare
Please note that this role is HYBRID with an in-office requirement of 3 days a week
#LI-Hybrid
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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$43,900.00 - $97,700.00
Top Skills
What We Do
Imagine Something New, Something Different.
Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families.
HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development.
HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC.
Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization.
Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
