Claims Audit & Training Specialist

Highmark Health; Montgomery (AL); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. is seeking a claims auditing professional to handle medical, dental, vision, FSA and HRA claims per internal procedures and plan wording. You will monitor audit workflows, maintain workload quality, and record results for monthly reporting.

Responsibilities include coaching junior staff, providing guidance on complex claims, and assisting with system upgrade testing. Strong communication and Excel/Word skills are required.

Qualifications

• 5 years prior medical dental, vision, FSA and HRA claims processing experience.
• 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 MS Word skills.

Responsibilities

• Ensure all claims are handled according to internal procedures and plan wording for each employer group.
• Monitor workflow of audits to meet turnaround time guidelines.
• Maintain workload in line with quality and production standards for the auditing team.
• Record results in the audit tool for monthly reporting.
• Provide guidance to the claims team with questions on all aspects of claims processing.
• Assist supervisor with specialized audits for SOC processes, carrier, vendor and employer audits.
• Handle system upgrade testing and other duties as assigned.

Skills

CPT

HCPCS

ICD-9

ICD-10

Attention to detail

Organizational skills

Problem solving

Communication (verbal & written)

PC navigation

MS Excel

Education

HS/GED

Associate degree (preferred)

Tools

MS Word

Job description

Highmark Inc. is seeking a claims auditing professional to handle medical, dental, vision, FSA and HRA claims per internal procedures and plan wording. You will monitor audit workflows, maintain workload quality, and record results for monthly reporting.

Responsibilities include coaching junior staff, providing guidance on complex claims, and assisting with system upgrade testing. Strong communication and Excel/Word skills are required.