Claims Audit Analyst

About the role

At Blue Cross Blue Shield Global Solutions℠ (BCBS Global Solutions℠), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that's simple, efficient, and human. Whether our customers live, work, travel, or study abroad, we give them the confidence and peace of mind to say "yes" to new possibilities.

You have an eye for detail and enjoy digging into complex claims to understand what's working, what isn't and where we can improve. You're comfortable making objective decisions, spotting patterns and turning what you find into practical insights that help strengthen claims quality. You're someone who:

• Takes pride in exceptional accuracy and getting the details right
• Enjoys spotting trends, inconsistencies and opportunities to improve
• Uses sound judgment and stays objective when reviewing others' work
• Can turn data and audit findings into clear, meaningful insights
• Communicates findings clearly and constructively
• Enjoys collaborating across teams to improve quality and processes

Responsibilities

Audit claims for quality and accuracy

• Review claims to ensure they're processed accurately, consistently and in line with company policies, client requirements and regulatory guidelines
• Conduct routine and random audits, including reviews of claims that exceed processor payment authority levels
• Support auditing requirements across Classic, BCBS Global Core, FEP and other assigned business lines
• Maintain audit schedules and complete required audit volumes within established timeframes

Turn findings into useful insights

• Track and document audit findings and maintain accurate records
• Analyze results to spot trends, recurring issues, training opportunities and operational risks
• Prepare monthly audit statistics and quality reports for leadership
• Turn findings into practical recommendations that improve quality, consistency and efficiency
• Help leadership understand what the data is telling us and where opportunities exist to improve

Support compliance and continuous improvement

• Support internal and external audit activities, including Association and client audits
• Review surcharge reports, approval queues and other quality-control processes
• Complete high-dollar claim notifications, stop-loss filings and related documentation
• Partner with operational teams to clarify findings and support corrective actions
• Share audit insights and best practices that help strengthen claims accuracy
• Collaborate with leadership to support training and continuous improvement efforts

Requirements

• 5+ years of experience in health insurance claims examination, adjudication or a related healthcare operations role
• Understand medical claims processing, benefit structures and insurance terminology
• Familiar with CPT, ICD-10 and healthcare reimbursement concepts
• Comfortable interpreting policies, identifying exceptions and documenting findings
• Analytical, organized and able to manage multiple priorities without losing attention to detail
• Communicate clearly, both verbally and in writing
• Comfortable using Microsoft Office and working within claims administration systems
• High school diploma or equivalent; additional education or certifications are a plus

Qualifications

• Claims quality auditing experience