Senior Special Investigative Unit Auditor

Premera Blue Cross

. Conduct retrospective and prospective audits of medical claims, provider billing, coding, and clinical documentation .

Posted 9/17/2026full-timeMountlake Terrace • Washington • United StatesSenior💰 $69,600 - $118,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims auditing, coding compliance, and fraud investigation, with a strong foundation in healthcare regulations and coding methodologies. Proficient in data analysis and stakeholder communication to drive process improvements and ensure compliance.

Highest-signal resume keywords

Certified Professional Coder (CPC)Accredited Healthcare Fraud Investigator (AHFI)Healthcare Coding AuditingData AnalyticsCompliance Investigation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CPT CodingHCPCS CodingICD-10-CM CodingDRG CodingRevenue Code ValidationFraud Prevention StrategiesAudit Findings PreparationClaims AnalysisHealthcare ComplianceCoding Methodologies

Soft Skills

Analytical SkillsProblem-Solving SkillsCommunication SkillsPresentation SkillsMentoring

Tools & Technologies

SIU Case Management SystemsSQLExcelAudit Tools

Certifications & Qualifications

Certified Professional Coder (CPC)Accredited Healthcare Fraud Investigator (AHFI)CPC-PCPMACCSCFECHC

Industry Keywords

Medical Claims AuditingProvider BillingClinical DocumentationFraud, Waste, and Abuse IndicatorsCompliance with Laws and Regulations

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Conduct retrospective and prospective audits of medical claims, provider billing, coding, and clinical documentation
Validate CPT, HCPCS, ICD-10-CM, DRG, modifier, and revenue code accuracy and reimbursement compliance
Apply medical terminology, anatomy, physiology, and disease-process knowledge when evaluating records
Analyze billing trends and data to identify suspicious activity, improper reimbursement, and emerging risk
Develop fraud prevention strategies and support provider education, remediation, and corrective action
Independently investigate complex issues and recommend next steps
Prepare audit findings, overpayment determinations, investigative documentation, and recommendations for leadership
Maintain confidentiality, chain-of-custody standards, and compliance with applicable laws, regulations, and coding guidance
Manage multiple audits and investigations, including priorities, timelines, deliverables, and stakeholder communication
Collaborate with internal and external partners and provide affidavits or sworn testimony when needed
Mentor junior auditors and lead process improvements and proactive audit initiatives

Requirements

What you’ll need

Bachelor’s degree in a related field or an equivalent combination of education and relevant experience (Required)
5 years of healthcare coding, auditing, SIU, compliance investigation, claims analysis, appeals, provider dispute, or related experience (Required)
Active Certified Professional Coder (CPC) and Accredited Healthcare Fraud Investigator (AHFI) credentials (Required)
Additional certification such as CPC-P, CPMA, CCS, CFE, or CHC preferred
Experience with SIU case management systems, SQL, Excel, and data analytics or audit tools
Advanced knowledge of coding methodologies, healthcare compliance requirements, and fraud, waste, and abuse indicators
Strong analytical, problem-solving, communication, and presentation skills

Benefits

Comp & perks

Medical, vision, and dental coverage with low employee premiums
Voluntary benefits, including pet insurance
Life and disability insurance
Retirement programs, including 401K employer match and a pension plan vested after 3 years of service
Wellness incentives, mental well-being resources, counseling services, stress management programs, and mindfulness programs
Generous paid time off
Tuition assistance for undergraduate and graduate degrees
Employee recognition program
Hybrid on-campus flexibility with access to on-site resources, networking opportunities, and team engagement
Commuter perks
Free convenient on-site parking
Subsidized on-campus cafes
On-site health and wellness activities
Fitness and well-being center with in-person and virtual workouts and nutritional counseling
Shuffleboard and ping pong on campus