Quality Audit Analyst

About the role

HCSC is hiring a Quality Audit Analyst in Helena, Montana, on a flex (hybrid) basis: three days in the office and two days remote. The position is responsible for planning and conducting detailed audits of programs related to quality and performance, and reviewing business transactions such as claims, inquiries or membership processes. It ensures internal controls and model audit rule requirements are followed and that processing is timely, accurate and complete in the appropriate systems.

Key responsibilities

• Plan and conduct detailed audits of quality and performance programs
• Analyze programs and review business transactions such as claims, inquiries or membership processes
• Verify that internal controls and model audit rule requirements are met
• Ensure processing is performed timely, accurately and completely in the right systems, following standard business processes

Required profile

• Bachelor's degree and 2 years of experience auditing claims, inquiries or membership in the health insurance industry, or 6 years of such experience
• Preferred: quality audit experience and knowledge of health insurance products
• Knowledge of state contract provisions
• Experience meeting deadlines

Required skills

• Knowledge of Blue Chip processing systems (e.g. BlueSTAR, CFE) and contract administration
• Medical terminology
• PC proficiency: Word, Excel, PowerPoint, EPPS, NICE, Live Meeting/WebEx and Lotus Notes
• Analytical and research skills, clear written and verbal communication, organizational and multi-tasking skills

What we offer

• Base pay range of $47,500 to $86,000, varying with skills, experience and location
• A role aligned with an annual incentive bonus plan subject to its terms and conditions
• Benefits including health and wellness, 401(k), pension, paid time off, paid parental leave, disability insurance, tuition reimbursement and more