Senior Special Investigative Unit (SIU) Auditor

About the role

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/.

Responsibilities

• Audit and Coding Review: Conduct retrospective and prospective audits of medical claims, provider billing, coding, and clinical documentation; validate CPT, HCPCS, ICD-10-CM, DRG, modifier, and revenue code accuracy and reimbursement compliance; apply knowledge of medical terminology, anatomy, physiology, and disease processes when evaluating records.
• Investigative Analysis and Fraud Prevention: Analyze billing trends and data to identify suspicious activity, improper reimbursement, and emerging risk; develop fraud prevention strategies and support provider education, remediation, and corrective action; use sound judgment to independently investigate complex issues and recommend next steps.
• Reporting, Compliance, and Case Documentation: Prepare clear audit findings, overpayment determinations, investigative documentation, and recommendations for leadership; maintain confidentiality, chain-of-custody standards, and compliance with applicable laws, regulations, and coding guidance.
• Legal Support, Collaboration, and Operational Execution: Manage multiple audits and investigations, coordinating priorities, timelines, deliverables, and stakeholder communication; collaborate with internal and external partners and provide affidavits or sworn testimony when needed; mentor junior auditors and lead process improvements and proactive audit initiatives.

Requirements

• Bachelor’s degree in a related field or an equivalent combination of education and relevant experience (Required)
• 5 years of healthcare coding, auditing, SIU, compliance investigation, claims analysis, appeals, provider dispute, or related experience (Required)
• Active Certified Professional Coder (CPC) and Accredited Healthcare Fraud Investigator (AHFI) credentials (Required)
• Additional certification such as CPC-P, CPMA, CCS, CFE, or CHC preferred
• Experience with SIU case management systems, SQL, Excel, and data analytics or audit tools
• Advanced knowledge of coding methodologies, healthcare compliance requirements, and fraud, waste, and abuse indicators
• Strong analytical, problem-solving, communication, and presentation skills

Benefits

• Medical, vision, and dental coverage with low employee premiums
• Voluntary benefit offerings, including pet insurance
• Life and disability insurance
• Retirement programs, including a 401K employer match and a pension plan vested after 3 years of service
• Wellness incentives with mental well‑being resources (counseling, stress management, mindfulness programs)
• Generous paid time off
• Tuition assistance for undergraduate and graduate degrees
• Employee recognition program

Schedule

This is a hybrid role. Premera’s on‑campus model offers flexibility to create your own routine with access to on‑site resources, networking opportunities, and team engagement. Commuter perks include free convenient on‑site parking and subsidized on‑campus cafes.

Pay

The salary range for this role is $69,600.00 – $118,300.00 (National Plus range, applicable to higher cost‑of‑labor markets such as Western Washington and Alaska). Compensation is based on geographic location, market conditions, and specific skills and experience.