Blue Cross Blue Shield of Michigan · 6 hours ago
Audit Specialist
Detroit, MI
Full-time
Onsite
Entry Level
2+ years expBlue Cross Blue Shield of Michigan is seeking an Audit Specialist to manage and maintain the accuracy of their membership database. The role involves processing enrollment files, conducting eligibility audits, and resolving discrepancies related to Medicare and Medicaid.
Health CareHealth Insurance
Responsibilities
Update and maintain accuracy of the membership database. This includes but not limited to: processing enrollment files, analytical and statistical error reports, electronic work queues, membership applications and batches for non-group products and Medigap
Responsible for reviewing, processing and maintaining membership eligibility audits (Medicare, Medigap, ESRD, Public Act 275, COBRA, Medicare Crossover Audits, and member level audits for non-group products)
Coordinate, monitor, and implement changes in accordance with underwriting guidelines for ACA, TEFRA, COBRA and Medicare
Investigate, research, and resolve discrepancies found in all audits
Coordinate, monitor, and provide liaison activities internally and externally for resolution of Medicare primary/ secondary payer status and Medicaid
Investigate and resolve monthly inquiries from Claims and other departments regarding Medicare. Coordinate discrepancies with CMS (member and group level). Coordinate discrepancies with BPCT and MDCH. Generate and distribute membership reports to applicable departments (i.e., Medicare Status Report, etc)
Other duties as assigned by leadership. Work on committees & lead as appropriate. Assist leadership in resolving non-Group eligibility and Medicare questions, and communicate resolutions externally and internally as appropriate
Qualification
Required
High School graduate or GED
Two (2) years of membership processing
Intermediate knowledge of underwriting guidelines
Extensive knowledge of BCN membership processing systems
Possess excellent verbal, written, organizational and problem solving skills
Ability to manage multiple priorities
Ability to establish and maintain good working relationships at all levels
Basic knowledge of Microsoft Word and Excel
Data entry requirement of 90NKPM with 90% accuracy
Preferred
Associates Degree or two (2) years of full time college credits in a Business related discipline
Knowledge of current Federal regulations such as ACA, COBRA, TEFRA, Medicare, Medicaid etc
Report writing and preparation skills
Company
Blue Cross Blue Shield of Michigan
We commit to being our members’ trusted partner by providing affordable, innovative products that improve their care and health.
5001-10000 employees
H1B Sponsorship
Blue Cross Blue Shield of Michigan 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 (66)
2024 (49)
2023 (38)
2022 (58)
2021 (74)
2020 (60)
Funding
Current Stage
Late StageLeadership Team
Daniel J. Loepp
President and CEO
Nancy Wanchik
Vice president & Medicaid CEO
Recent News
2026-01-06
2025-10-15
24-7 Press Release Newswire
2025-10-03
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