Claims Audit & Compliance Specialist

Highmark Health; Pennsylvania; On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Health in Pennsylvania is seeking a Claims Auditor to review medical, dental, vision, FSA and HRA claims for accuracy and compliance. You will examine coding, benefit rules and documentation, and document audit results to support monthly reporting.

The role requires detail orientation, strong problem-solving and communication skills, and the ability to work independently or within a claims team in a fast-paced environment.

Qualifications

• 5 years prior medical, dental, vision, FSA and HRA claims processing experience.
• Knowledge of CPT, HCPCS, ICD9 and ICD10.
• Strong attention to detail with organizational skills.
• Excellent verbal and written communication.
• Proficient PC navigation; basic MS Excel and Word.
• Ability to work independently or in a team.
• Ability to reference resources to resolve claim audits.

Responsibilities

• Audit claims and monitor audits for timely turnaround.
• Prepare and maintain audit results for monthly reporting.
• Provide coaching and guidance to claims staff.
• Support system upgrade testing and special audits.
• Handle refunds, voids, and stop payments.
• Liaise with clients and management regarding audits and findings.

Skills

CPT/HCPCS/ICD10

Attention to detail

Problem solving

Communication skills

MS Excel

MS Word

Teamwork

Education

HS/GED

Associate degree (preferred)

Tools

Excel

Word

Claims processing system

Job description

Highmark Health in Pennsylvania is seeking a Claims Auditor to review medical, dental, vision, FSA and HRA claims for accuracy and compliance. You will examine coding, benefit rules and documentation, and document audit results to support monthly reporting.

The role requires detail orientation, strong problem-solving and communication skills, and the ability to work independently or within a claims team in a fast-paced environment.