Claims Audit & Training Specialist

Highmark Health; Phoenix (AZ); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. is seeking an experienced claims auditor to ensure all medical, dental, vision, FSA and HRA claims are processed according to internal procedures and plan documents.

You will monitor audits, coach staff, and ensure timely turnaround while maintaining quality standards. The role requires 5 years of claims processing experience, strong CPT/HCPCS/ICD coding knowledge, and solid communication skills.

Qualifications

• Comprehensive understanding of CPT, HCPCS, ICD9 and ICD10 medical coding.
• Strong attention to detail with organizational skills.
• Excellent problem solving and ability to work in a fast paced production environment.
• Excellent written and verbal communication skills.
• Basic PC navigation in a professional work environment.
• Basic MS Excel and MS Word proficiency.
• Ability to make sound decisions referencing available resources.
• Ability to work independently and in a team.

Responsibilities

• Ensure claims handled per internal procedures and plan documents.
• Monitor audit workflow for timely turnaround and identify performance groups.
• Maintain workload to meet defined quality standards.
• Record audit results and assist in training sessions.
• Coach claims staff, especially trainees.
• Provide recommendations for dollar authorization based on audits.
• Assist with SOC, carrier, vendor and employer audits as needed.
• Maintain knowledge of benefits, regulations, and system upgrades.
• Review complex claim situations to render sound decisions.
• Liaise with clients, management, and internal teams using strong communication.
• Manage refunds, voids, and stop payments processes.
• Guide claims team on all aspects of processing.
• Assist with system upgrade testing.
• Handle other duties as assigned.

Skills

Medical coding (CPT/HCPCS/ICD9/ICD10)

Attention to detail

Problem solving

Communication skills

PC navigation

MS Excel

MS Word

Judgement & decision making

Education

HS/ GED

Associate degree preferred

Tools

Job description

Highmark Inc. is seeking an experienced claims auditor to ensure all medical, dental, vision, FSA and HRA claims are processed according to internal procedures and plan documents.

You will monitor audits, coach staff, and ensure timely turnaround while maintaining quality standards. The role requires 5 years of claims processing experience, strong CPT/HCPCS/ICD coding knowledge, and solid communication skills.