Audit Specialist II

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Job Summary

The Audit Specialist Analyst II is responsible for independently executing internal and external audits, interpreting audit findings, validating compliance with contractual performance guarantees, and supporting broader quality assurance initiatives. This role requires advanced knowledge of Affordable Care Act, Commercial, Medicare and Medicaid reimbursement methodologies, including facility, ancillary, and professional claims, as well as the ability to analyze claim calculations, interpret provider contracts, collaborate with cross-functional teams, and identify opportunities to improve audit accuracy, compliance, and operational performance.

Required Job Qualifications:

• Bachelor's degree or equivalent experience in claims processing or audit.

• 2 years in audit or claims review.

• Familiarity with adjudication systems.

• Proficient in Microsoft Office and audit software.

• Strong analytical and communication skills.

Preferred Job Qualifications:

• Experience in payment integrity or provider contracting - HIGHLY PREFERRED

• Extensive experience across ACA, Commercial, Medicare, and Medicaid plans, including reimbursement methodologies and payment structures

• Strong expertise in facility, ancillary, and professional billing, coding, and reimbursement practices

• Proven ability to interpret provider contracts and perform detailed claim reviews, calculations, and variance analysis

• Advanced analytical, critical thinking, and problem-solving skills to assess risks and recommend corrective actions

• Excellent communication and collaboration skills, with the ability to present findings, manage priorities independently, and partner effectively across stakeholders

Sponsorship will not be provided for this role.

This is a Telecommute (Remote) role.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$41,700.00 - $92,800.00

Exact compensation may vary based on skills, experience, and location.

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For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.

Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at View phone number on click.appcast.io to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas,

Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association

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