Blue Cross & Blue Shield of Mississippi · 1 month ago
Auditor, Special Investigations
Flowood, MS
Full-time
Onsite
Mid Level
3+ years expBlue Cross & Blue Shield of Mississippi promotes health and wellness while encouraging professional growth. The Auditor in Special Investigations is responsible for conducting audits of Network Providers to ensure compliance and identify fraud, waste, and abuse, while collaborating with various teams to implement monitoring and controls.
Health InsuranceInsuranceNon Profit
Responsibilities
Conducting comprehensive audits of Network Providers (Institutional, Professionals and Allied) for compliance and to identify and remediate Provider fraud, waste and/or abuse
Collaborates with Management and the Provider Compliance team to implement proactive Provider billing monitoring designed to identify potential fraud, waste and abuse
Responsible for collaborates with the Clinical Quality and Claims Operations Business Areas to identify and address fraud, waste and abuse and implement controls to address identified fraud, waste and abuse and quality issues
Qualification
Required
A Bachelor's Degree in Business or other health related field
Three (3) years audit experience
Experience in interpretation of data analysis and analytical reporting
PC skills required to include the Microsoft Office Suite
Effective oral and written communications skills
Preferred
Experience in auditing Institutional providers or other related provider auditing
Healthcare experience
Benefits
Comprehensive benefits package that is worth approximately one-third of the salary compensation
Benefits program is among the best in the health care field
Company
Blue Cross & Blue Shield of Mississippi
Blue Cross & Blue Shield of Mississippi is a mutual insurance company that provides health insurance services.
1001-5000 employees
H1B Sponsorship
Blue Cross & Blue Shield of Mississippi has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (15)
2024 (26)
2023 (11)
2022 (24)
2021 (8)
2020 (11)
Funding
Current Stage
Late StageLeadership Team
Lindsey Tong Sisneros
Executive Assistant to the Chief Financial Officer
Marc A. Dunn
Director of Provider Partnerships
Company data provided by crunchbase