Full-Time

Investigative Analyst

Confirmed live in the last 24 hours

HCSC

HCSC

Health insurance provider in multiple states

Financial Services
Healthcare

Compensation Overview

$43.9k - $97.7kAnnually

Junior, Mid

Chicago, IL, USA + 1 more

More locations: Richardson, TX, USA

Hybrid role with an in-office requirement of 3 days a week.

Category
Financial Analysis
Forensic Accounting
Accounting
Required Skills
SQL
Requirements
  • Bachelor’s degree from an accredited college AND 2 years of general knowledge of claims processing operations and contract and benefit administration, financial control procedures, and statistics OR 6 years of health care investigative experience, including exposure to one or more of the following functional areas: claims processing operations; contract administration; claims coding; and/ or finance and accounting, OR law enforcement experience
  • Clear, concise communication skills, and strong analytical and quantitative skills.
  • Experience with the Microsoft Office 365 product suite, with an emphasis on Excel and Access.
  • Analytical and quantitative skills
  • Knowledge of medical practice patterns.
  • Experience working in a financial, accounting, criminal justice, or legal environment.
  • Exposure to programming languages, such as SQL.
  • Certified Coder
  • Investigative Accreditation (AHFI, or CFE)
  • Knowledge of Medicare
Responsibilities
  • planning and conducting investigations and audits of potentially abusive/aberrant billing practices and other provider/member issues
  • identifying and resolving internal issues
  • tracking the data and potentially coordinating with other areas of the corporation in an effort to improve future outcomes
  • planning and coordinating the activities of Provider Claims Analyst in support of potential investigations and audits
  • Utilizing existing database information to identify patterns of abusive/aberrant billing practices by both our provider and member community
  • recommending system and internal control enhancements to reduce the potential for adjudication errors

HCSC provides health insurance services across five states: Illinois, Montana, New Mexico, Oklahoma, and Texas. The company offers a variety of health insurance plans designed for individuals, families, and businesses, ensuring that different healthcare needs are met. HCSC's plans work by collecting premiums from members, which fund the healthcare services they provide. In addition to insurance, HCSC invests in health and wellness programs aimed at lowering healthcare costs and enhancing the health outcomes of its members. What sets HCSC apart from other health insurance providers is its long-standing experience in the industry and its commitment to compassion and innovation in healthcare. The company's goal is to empower people to lead healthier lives while maintaining a focus on quality care.

Company Stage

N/A

Total Funding

$472.7M

Headquarters

Chicago, Illinois

Founded

N/A

Simplify Jobs

Simplify's Take

What believers are saying

  • The new Houston office will create numerous job opportunities, fostering local economic growth and community development.
  • The acquisition of Cigna's Medicare businesses will expand HCSC's product offerings and geographic reach, benefiting current and future members.
  • Recognition as one of the 'Best Places to Work in IT' and having a CEO listed among the 'Most Influential People in Healthcare' highlight HCSC's strong leadership and positive work environment.

What critics are saying

  • The $231,900 fine from the Illinois Department of Insurance for an inaccurate provider directory could damage HCSC's reputation and trust with members.
  • The integration of Cigna's Medicare businesses may pose operational challenges and potential disruptions.

What makes HCSC unique

  • HCSC's strategic expansion into local communities, such as the new Houston office, emphasizes its commitment to economic growth and local workforce development, setting it apart from competitors.
  • The acquisition of Cigna's Medicare businesses significantly enhances HCSC's capabilities and reach in the growing Medicare market, providing a competitive edge.
  • HCSC's collaboration with Feeding America to address root causes of hunger showcases its holistic approach to community health, beyond traditional healthcare services.

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