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.

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-Hybrid

This role is 3 in-office and 2 days remote at our Helena, MT location

Compensation: $41,700.00 - $92,800.00

Exact compensation may vary based on skills, experience, and location

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.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards