Claims Audit Specialist - BCI & Training

Highmark Health Company; Trenton (NJ); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. is seeking a claims auditing professional to ensure compliance with internal procedures, review plan wording, and monitor audit workflows. You will record results, train staff, and advise on dollar authorizations while supporting SOC, carrier, vendor, and employer audits as needed.

The role requires 5 years of claims processing experience in medical, dental, vision, FSA, and HRA, with strong CPT/ICD coding knowledge. Strong communication and independence are essential.

Qualifications

• Comprehensive understanding of CPT, HCPCS, ICD9 and ICD10 coding.
• Strong attention to detail and organizational skills.
• Ability to work in a fast-paced production environment and solve problems.
• Clear written and verbal communication; proficient MS Office basics.

Responsibilities

• Audit claims according to procedures and monitor audit workflow.
• Record results for monthly reporting and assist in training sessions.
• Coach and guide the claims team, especially trainees.
• Provide recommendations for claims dollar authorization as needed.
• Assist with system upgrade testing and other duties as assigned.

Skills

Medical coding CPT

Medical coding HCPCS

Medical coding ICD9/ICD10

Attention to detail

Problem solving

Communication skills

PC navigation

MS Excel

MS Word

Judgement

Teamwork / independent work

Education

HS/GED

Associate Degree preferred

Job description

Highmark Inc. is seeking a claims auditing professional to ensure compliance with internal procedures, review plan wording, and monitor audit workflows. You will record results, train staff, and advise on dollar authorizations while supporting SOC, carrier, vendor, and employer audits as needed.

The role requires 5 years of claims processing experience in medical, dental, vision, FSA, and HRA, with strong CPT/ICD coding knowledge. Strong communication and independence are essential.