Medical Claims Auditor & QA Coach

Highmark Health; Helena (MT); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. in Helena, Montana is seeking an experienced claims auditor to ensure claims are handled according to internal procedures, plan documents, and benefit summaries. The role requires deep knowledge of CPT, HCPCS, ICD codes, and strong attention to detail in a fast-paced environment.

You will monitor audits, record results, and provide training to the claims team. Superior communication and independent work style are essential, with ability to coach colleagues and support system

Qualifications

• Comprehensive CPT/HCPCS/ICD9/ICD10 coding knowledge.
• Strong attention to detail and organizational skills.
• Problem solving in fast-paced production environment.
• Excellent written and verbal communication.
• Proficient PC navigation for a professional work environment.
• Basic MS Excel and MS Word skills.
• Ability to make sound decisions using available resources.
• Ability to work independently and in a team.

Responsibilities

• Ensure claims are processed according to procedures and plan documents.
• Monitor audit workflow to meet turnaround time.
• Record audit results and support monthly reporting.
• Provide coaching to claims staff and trainees.
• Recommend dollar authorization based on audits.
• Assist with specialized SOC, carrier, vendor, and employer audits.
• Maintain knowledge of benefits, regulations, and system upgrades.
• Support system upgrade testing and other duties.

Skills

CPT/HCPCS/ICD9/ICD10 expertise

Attention to detail

Problem solving

Communication skills

PC navigation

MS Excel

MS Word

Judgement for sound decisions

Teamwork

Education

HS/GED

Associate degree preferred

Job description

Highmark Inc. in Helena, Montana is seeking an experienced claims auditor to ensure claims are handled according to internal procedures, plan documents, and benefit summaries. The role requires deep knowledge of CPT, HCPCS, ICD codes, and strong attention to detail in a fast-paced environment.

You will monitor audits, record results, and provide training to the claims team. Superior communication and independent work style are essential, with ability to coach colleagues and support system