Quality Audit Analyst

About the role

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.

Responsibilities

• Planning and conducting detailed audits, analyzing programs related to quality and performance.
• Reviewing business transactions such as claims, inquiry or membership, processes etc to assure that internal controls and model audit rule requirements are adhered to.
• Ensuring processing is performed timely, accurately, and completely in the appropriate systems in accordance with standard business processes.

Requirements

• Bachelor's 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.

Skills

• Knowledge of various Blue Chip processing systems (e.g., 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 workload and meet aggressive deadlines and timetables.
• Knowledge of state contract provisions.
• Knowledge of sold case materials and departmental documents.
• PC proficiency including Word, Excel, PowerPoint, EPPS, NICE, Live Meeting/WebEx, and Lotus Notes.
• Experience meeting deadlines.

Preferred Qualifications

• Quality audit experience.
• Knowledge of health insurance products.

Schedule

This role is 3 days in‑office and 2 days remote at the Helena, MT location.

Pay

Compensation: $41,700.00 – $92,800.00 (exact compensation may vary based on skills, experience, and location).