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Health Care Service Corporation
Health Care Service Corporation
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Health Care Service Corporation (HCSC) is an independent licensee of the Blue Cross Blue Shield Association and a major U.S. health insurance and healthcare services organization. It serves nearly 23 million people through coverage and benefit programs for employers, individuals, families, and members of Medicare and Medicaid. Beyond health insurance, HCSC provides pharmacy services, life and dental coverage, and health data technology. With nearly a century of experience, the company works across insurance, healthcare, and consulting to expand access to care, support better health outcomes, and help manage costs for members and communities. Its broad operations create career opportunities spanning health benefits, healthcare services, technology, data, and related business functions.
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Coding Investigator Auditor (Remote, U.S.)

Health Care Service Corporation seeks a remote Coding Investigator Auditor to validate clinical, billing, and coding claims across eligible U.S. locations. The role audits payments, researches discrepancies, documents findings, and coordinates investigations.

USUnited StatesILIllinoisMTMontanaNMNew MexicoOKOklahomaTXTexas
$63,300 – $114,300 / year
RemoteFull-timeMiddleSeniorEnglish RequiredAuditor

Description

  • Review clinical, billing, coding, and lowest-cost-setting services before and after payment
  • Apply medical, contractual, legislative, policy, and related information to validate submitted and billed claims
  • Research relevant issues and records
  • Document audit findings clearly and accurately
  • Consult with special investigations and affordability-of-care teams when needed
  • Coordinate with the medical director, special investigations, customer service, PASS, network management, marketing, case management, medical review, legal, pricing, and database departments

Requirements

  • Bachelor’s degree required; one year of business, law enforcement, or regulatory agency experience may substitute for each year of college
  • Hold a certified coding credential or obtain one within 24 months of hire
  • Bring three years of experience with claims processing operations and reporting systems, including two years auditing or developing computer system reports
  • Understand accreditation standards such as URAC and NCQA, along with health insurance legislation
  • Understand claims processes and claims processing systems
  • Demonstrate PC proficiency with Microsoft Word, Excel, and health insurance databases
  • Communicate effectively in writing and verbally with physicians, members, and providers, and prepare and explain documented findings
  • Demonstrate strong organization and prioritization skills
  • Current AAPC Medical Coding Certification is preferred
  • Work remotely within the continental United States, excluding California, New York, Alaska, and Hawaii

Benefits

  • Annual incentive bonus plan
  • Health and wellness benefits
  • 401(k) savings plan
  • Pension plan
  • Paid time off
  • Paid parental leave
  • Disability insurance
  • Supplemental life insurance
  • Employee assistance program
  • Paid holidays
  • Tuition reimbursement
  • Additional incentive programs
  • Professional development opportunities
  • Remote work arrangement

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