Be part of a vision for a healthier Mississippi as a Senior Clinical Compliance Auditor.

At Blue Cross & Blue Shield of Mississippi, we’re not just about providing health insurance, we are creating a strong, supportive community which encourages every Mississippian to live their healthiest life. This mission requires a talented and motivated team with diverse sets of skills and experiences, aligned with the commitment of a healthy Mississippi.  By combining strong financial stewardship with a focus on the Health & Wellness of Mississippians, we invest in programs, partnerships, and innovations which drive quality care, lower costs, and healthier lives. 

We are seeking a Senior Clinical Compliance Auditor to act as the primary clinical reviewer of analytical findings, complaints, formal referrals, and appeals related to the care or services provided by Network Hospitals, Providers, Pharmacies and other entities.  This Senior Auditor reviews suspected instances of inappropriate billing of claims to Blue Cross & Blue Shield of Mississippi.

What You’ll Do: 

• Conducts clinical reviews of medical records against guidelines, Provider contracts, Member Benefit Plan language and Medical Policy criteria. Gathers information from Members to aid in the review.
• Consults with Medical Director and Legal Operations with related questions during the auditing process.
• Reviews data analytical findings to identify aberrant patient care, utilization or billing practices.
• Determines and recommends appropriate interventions to address and resolve potential fraud, waste and abuse issues.
• Follows thorough clinical analysis, reports and recommends corrective action.
• Prepares written reports of audit outcome and conclusions with details of findings.

Why Join Us

Purpose-Driven Work: Make a meaningful impact on the Health & Wellness of our Members.
Career Growth: Clear pathways to grow your career where your skills flourish.
Learning & Development: Build upon clinical knowledge as we coordinate holistic, Member-centered care.

Healthy Culture: Work in an environment with a focus on your health which allows you to thrive. The walking track, onsite gym and café are just a few of the highlights of the campus. 
Compensation & Benefits: We offer a highly competitive compensation package that includes medical benefits, 401(k), ample paid time off and a schedule that supports true work/life balance
 

How to Apply and the Process:

• Set up a Workday account and complete your application process.
• Attach a copy of a resume and cover letter.
• Check your email for updates.
• Processes may include phone screen, testing, in-person interview (s), background and drug testing.
• Questions? Email us! Recruiting@bcbsms.com 
   

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

It’s good to be Blue!