Senior Claims Audit & Compliance Specialist

Highmark Health; Augusta (ME); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. in Augusta, ME seeks a claims auditing specialist to ensure accurate processing of medical, dental, vision, FSA and HRA claims while upholding plan documents and regulations.

You will record audit results, support monthly reporting, and coach junior staff to improve accuracy and throughput. The role requires deep CPT/HCPCS/ICD coding knowledge, strong problem solving and communication skills, and the ability to work well in a fast-paced environment with both independent and team

Qualifications

• Proficiency with CPT, HCPCS, ICD9 and ICD10 coding required.
• Detail-oriented with strong organizational skills.
• Able to solve problems quickly and accurately.
• Excellent written and verbal communication abilities.
• Proficient in MS Excel and Word; ability to navigate PC systems.
• Ability to work independently and as part of a team.

Responsibilities

• Audit and process medical, dental, vision, FSA and HRA claims.
• Ensure compliance with internal procedures and plan documents.
• Record results in audit tools; monthly reporting.
• Provide coaching and guidance to trainee staff.
• Assist with audits for SOC processes, carriers and employers.
• Maintain knowledge of benefits, regulations, and system upgrades.

Skills

Medical coding (CPT/HCPCS/ICD9/ICD10)

Attention to detail

Problem solving

Communication skills

PC navigation

MS Excel

MS Word

Independent and team work

Judgement

Fast-paced environment

Education

HS/GED

Associate Degree (preferred)

Job description

Highmark Inc. in Augusta, ME seeks a claims auditing specialist to ensure accurate processing of medical, dental, vision, FSA and HRA claims while upholding plan documents and regulations.

You will record audit results, support monthly reporting, and coach junior staff to improve accuracy and throughput. The role requires deep CPT/HCPCS/ICD coding knowledge, strong problem solving and communication skills, and the ability to work well in a fast-paced environment with both independent and team