Blue Cross & Blue Shield of Rhode Island · 2 days ago
Claims Audit Coordinator
Providence, RI
Full-time
Onsite
Mid Level
$54K/yr - $79K/yr
3+ years expBlue Cross & Blue Shield of Rhode Island is dedicated to serving Rhode Islanders and ensuring compliance in healthcare processes. The Claims Audit Coordinator will conduct audits of claims coding and benefit payments, providing recommendations for process improvements based on findings.
Insurance
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
Qualification
Required
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
Preferred
Knowledge of Blue Cross & Blue Shield products
Experience conducting quality assurance reviews
Knowledge of claims coding
Benefits
Flexible work arrangements that include remote and hybrid opportunities
Paid time off
Tuition reimbursement
Assist with student-loan repayment
Health, dental, and vision insurance
Programs that support your mental health and well-being
Competitive pay
Bonuses
Investment plans
Additional paid time to volunteer
Company
Blue Cross & Blue Shield of Rhode Island
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), we know that health is more than what happens at the doctor’s office.
501-1000 employees
H1B Sponsorship
Blue Cross & Blue Shield of Rhode Island 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 (4)
2024 (4)
2023 (2)
2022 (4)
2021 (3)
Funding
Current Stage
Late StageLeadership Team
Martha Wofford
President and CEO
James Joy
Chief Financial Officer - Retired
Company data provided by crunchbase