Payment Integrity Financial Specialist

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE

Provides advanced technical, analytical, and financial support for Payment Integrity programs through the analysis, reconciliation, monitoring, and validation of financial and operational data. This role ensures the accuracy of program payments, billings, vendor financial activity, and cost containment initiatives while delivering actionable insights that improve operational performance, financial outcomes, and regulatory compliance.

How You Contribute to the Company's Mission In This Role

• Analyze and reconcile Payment Integrity program payments, billings, vendor invoices, and related financial transactions to ensure accuracy and compliance.
• Validate vendor invoices and payments against contractual terms, expected savings, and program performance metrics.
• Perform financial analysis, variance reporting, cost savings validation, and performance monitoring for Payment Integrity initiatives.
• Identify discrepancies, conduct root cause analyses, and partner with internal and external stakeholders to resolve issues and improve processes.
• Develop methodologies, reports, and data-driven recommendations that support operational efficiency, financial stewardship, and strategic decision-making.
• Serve as a subject matter expert for Payment Integrity financial and operational data while supporting audit, compliance, and cross-functional initiatives.

Required Qualifications

• Bachelor's degree in Healthcare, Finance, Accounting, Business Administration, or a related field; 4 years of related experience may be substituted in lieu of a degree.
• 2 years of healthcare industry experience in one or more of the following areas: Financial analysis, Payment integrity or reimbursement analysis, Provider contract analysis, Internal audit, and/or Value-based care programs
• 1 year of experience solving complex business, financial, or clinical problems through data analysis.
• Experience performing financial reconciliations involving payments, invoices, billing activity, and General Ledger transactions.
• Strong analytical, mathematical, and problem-solving skills with demonstrated attention to detail and accuracy.
• Excellent written and verbal communication skills, including the ability to present findings and recommendations to leadership.
• Advanced proficiency with Microsoft Excel and Microsoft Office applications.
• Ability to analyze, interpret, reconcile, and summarize large volumes of financial and operational data.
• Ability to work independently in a fast-paced, deadline-driven environment.

Preferred Qualifications

• Certified Professional Coder (CPC) certification upon hire; required within two years of placement in the role.
• Experience reviewing and validating vendor invoices, payment calculations, and financial performance guarantees.
• Knowledge of healthcare claims processing systems, reimbursement methodologies, and health plan operations.
• Experience with provider reimbursement reviews, including compounded drug claim reimbursement calculations.
• Experience supporting Accounts Payable, Accounts Receivable, or similar financial operations.
• Knowledge of internal controls, audit practices, regulatory compliance, and financial governance requirements.
• Experience with relational databases, SQL, data reporting, and business intelligence tools.
• Understanding of Inter-Plan Payment Integrity activities and related reporting requirements.
• Proven ability to identify opportunities for process improvement, operational efficiency, and cost containment.

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

An Equal Opportunity Employer

All internal employees please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account. 

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free. 

We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.