Blue Cross of Idaho · 8 hours ago
Claims Investigative Examiner
Meridian, ID
Full-time
Onsite
Mid, Senior Level
$60K/yr - $84K/yr
5+ years expBlue Cross of Idaho is seeking a Claims Investigative Examiner who will conduct claim reviews and investigations of health insurance fraud, waste, and abuse. The role involves auditing claims, processing outcomes of investigations, and ensuring compliance with company policies and regulatory requirements.
Health InsuranceInsurance
Responsibilities
Participate in the development of payment accuracy audit methods, business rules, policies, and procedures
Perform audits of billing, clinical, and other records
Interpret, apply, and compare records with company contracts, policies, legal, and regulatory requirements
Review and investigate claims identified by anomaly data models, fraud detection software, and other data sources, to identify incorrect reimbursement or substantiate patters of suspected activity
Review claim and determines denial, acceptance, or a need for further investigation
Review existing claims for errors and omissions
Process complex claims, coordination of benefits, and claims adjustments
Ability to work well under pressure in a complex and rapidly changing environment
Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads
Ability to work independently and as a team member
May perform coaching and mentor employees, as necessary
Researcher projects, as assigned
Perform other duties and responsibilities as assigned
Qualification
Required
5 years processing complex claims and adjustments
Preferred
Certified Professional Coder (CPC)
Facility coding experience
Ability to read medical records and coding
Strong creative and analytical thinking
Strong problem solving
Excellent verbal and written communication
Excellent interpersonal skills
Ability to research and navigate the system
Benefits
Paid time off
Paid holidays
Community service and self-care days
Medical/dental/vision/pharmacy insurance
401(k) matching and non-contributory plan
Life insurance
Short and long term disability
Education reimbursement
Employee assistance plan (EAP)
Adoption assistance program
Paid family leave program
Company
Blue Cross of Idaho
Blue Cross of Idaho operates as a health insurance company.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Sameer Sonalkar
SVP & CIO, Blue Cross of Idaho
Recent News
2025-07-28
2025-07-28
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