Senior Claims Audit & Quality Assurance Specialist

Highmark Health; Lincoln (NE); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. is seeking an experienced claims auditor to ensure accurate processing of medical, dental, vision, FSA, and HRA claims.

The role includes auditing workflows, recording results for monthly reporting, and coaching staff to maintain quality and compliance. Candidates should have extensive CPT/HCPCS/ICD9/ICD10 knowledge, strong communication skills, and proficiency with MS Excel/Word in a fast-paced production environment.

Qualifications

• Experience with CPT/HCPCS/ICD9/ICD10 coding and claims processing.
• Strong attention to detail and organizational skills.
• Ability to work in a fast-paced production environment and solve problems.

Responsibilities

• Handle medical/dental/vision/FSA/HRA claims processing tasks.
• Monitor audit workflow to ensure timely turnaround times and accuracy.
• Record results and assist with monthly reporting of audits.
• Provide coaching and guidance to claims staff as needed.
• Assist with system upgrade testing and issue resolution.

Skills

Medical/dental/vision/FSA/HRA claims

Auditing & QA

Communication skills

MS Excel basics

MS Word basics

Education

HS/GED

Associate Degree

Tools

MS Excel

MS Word

Job description

Highmark Inc. is seeking an experienced claims auditor to ensure accurate processing of medical, dental, vision, FSA, and HRA claims.

The role includes auditing workflows, recording results for monthly reporting, and coaching staff to maintain quality and compliance. Candidates should have extensive CPT/HCPCS/ICD9/ICD10 knowledge, strong communication skills, and proficiency with MS Excel/Word in a fast-paced production environment.