Claims Audit Specialist & Trainer

Highmark Health; Boston (MA); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Health is seeking a claims auditing professional to ensure accurate handling of medical, dental, vision, FSA and HRA claims in line with plan documents and internal procedures.

You will coach the claims team, review CPT/HCPCS/ICD coding, monitor audits, and prepare monthly reports while liaising with clients and management.

The role requires strong communication, attention to detail, Excel/Word proficiency, and ability to work independently or in a team.

Qualifications

• Comprehensive understanding of CPT, HCPCS, ICD9 and ICD10 medical coding.
• Strong attention to details along with organizational skills.
• Excellent problem solving with the ability to work in a fast paced production environment.
• Excellent communication skills both verbal and written.
• Basic MS Excel and Basic MS Word proficiency.

Responsibilities

• Review claims according to internal procedures and plan documents.
• Monitor audit workflow to ensure timely turnaround times.
• Record results in audit tools and report monthly.
• Coach and train claims staff on audit findings.
• Assist with system upgrade testing and SOC audits as needed.
• Liaise with clients and management to resolve issues.

Skills

Medical coding

Attention to detail

Problem solving

Verbal & written communication

MS Excel

MS Word

Independent work

Team collaboration

Education

HS/GED

Associate degree preferred

Job description

Highmark Health is seeking a claims auditing professional to ensure accurate handling of medical, dental, vision, FSA and HRA claims in line with plan documents and internal procedures.

You will coach the claims team, review CPT/HCPCS/ICD coding, monitor audits, and prepare monthly reports while liaising with clients and management.

The role requires strong communication, attention to detail, Excel/Word proficiency, and ability to work independently or in a team.