Claims Audit Specialist (BCI)

Highmark Health; Carson City (NV); On-site; USD 46,000 - 68,000; Full time

Job summary

Highmark Inc. is seeking a claims auditor to ensure accurate processing of medical/dental/vision claims in a fast-paced environment. The role requires CPT/HCPCS/ICD coding knowledge and 5 years of claims experience, with strong problem-solving and communication skills.

HS/GED is required; an Associate degree is preferred. Responsibilities include coaching staff, auditing work, and assisting with system upgrades.

Qualifications

• HS/GED required for the position.
• 5 years of medical, dental, vision, FSA and HRA claims processing experience.
• CPT/HCPCS/ICD9-ICD10 coding knowledge.
• Proficient in Excel and Word; strong communication.

Responsibilities

• Audit and review claims processing for compliance and accuracy.
• Coach trainee staff and provide guidance on processes.
• Record results and assist with system upgrades testing.
• Liaise with clients and management to resolve issues.
• Manage refunds, voids, and stop payments.

Skills

CPT/HCPCS/ICD codes

Attention to detail

Problem solving

Communication skills

MS Excel basics

MS Word basics

Independent work

Team collaboration

Education

HS/GED

Associate degree (preferred)

Tools

Excel

Word

Job description

Highmark Inc. is seeking a claims auditor to ensure accurate processing of medical/dental/vision claims in a fast-paced environment. The role requires CPT/HCPCS/ICD coding knowledge and 5 years of claims experience, with strong problem-solving and communication skills.

HS/GED is required; an Associate degree is preferred. Responsibilities include coaching staff, auditing work, and assisting with system upgrades.