Claims Audit Coordinator

Blue Cross & Blue Shield of Rhode Island • Providence, RI

3d • Hybrid

About The Position

At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We’re dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer. Why this job matters: Conduct routine and complex audits of claims coding, processing, pricing and benefit payments, customer service calls, and enrollment information to ensure compliance with policies and procedures. Provide recommendations and action plans for process changes based on findings. Report operational performance as required by the Blue Cross Blue Shield Association (BCBSA), company, and account guarantees.

Requirements

• Associate or Bachelor’s degree, or related field, or an equivalent combination of education and experience
• Three to five years of experience in claims review, processing, or adjudication or experience in customer service within a health insurance organization
• Knowledge of claims processing or membership administration for all lines of business
• Ability to research data, identify trends and recommend appropriate actions
• Detail oriented
• Ability to work successfully in a matrix environment
• Demonstrated written and verbal communications skills
• Ability to exercise sound judgment
• Ability to establish and maintain strong working relationships with various stakeholders
• Ability to organize work efficiently to meet established time and quality standards
• Good organization skills
• Good time management skills
• Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, etc

Nice To Haves

• Knowledge of Blue Cross & Blue Shield products
• Experience conducting quality assurance reviews
• Knowledge of claims coding

Responsibilities

• Conduct reviews of claims coding and benefit payments to identify errors in processing and payment and to ensure claims are settled according to company policies and procedures.
• Audit calls to ensure accuracy in accordance with BCBSA guidelines
• Conduct accuracy and/or timeliness reviews in the areas of claims, inquiries, or enrollment to determine whether work was performed accurately and within specified timeframes.
• Research cause of errors to determine origin; provide recommendations and action plans for process improvements.
• Present audit and review findings with supervisor, business owners, and team members.
• Collaborate with internal areas to implement process changes.
• Prepare audit report findings for supervisor, business owners, and team members.
• Assist with department initiatives and projects.
• Perform other duties as assigned.

Benefits

• flexible work arrangements that include remote and hybrid opportunities and paid time off
• tuition reimbursement
• assist with student-loan repayment
• health, dental, and vision insurance as well as programs that support your mental health and well-being
• pay competitively, offer bonuses and investment plans
• committed to growing and developing our employees
• associates receive additional paid time to volunteer

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree