Senior Claims Audit & Quality Coach

Highmark Health; Santa Fe (NM); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. is seeking a claims professional to ensure accurate processing and audit compliance across medical, dental, vision, FSA, and HRA claims. You will review plan documents, monitor audits, and coach staff to meet service levels.

The role requires 5 years of claims processing experience, strong CPT/HCPCS/ICD coding, and solid communication skills. You will collaborate with cross-functional teams and support system upgrades while ensuring high-quality outcomes.

Qualifications

• Minimum 5 years of medical claims processing experience.
• Strong CPT/HCPCS/ICD9 coding knowledge.
• Detail-oriented with organizational skills.
• Able to work in a fast-paced production environment.
• Excellent written and verbal communication.
• Ability to use MS Excel and MS Word effectively.

Responsibilities

• Review plan documents and benefit summaries for employer groups.
• Monitor audit workflows and meet turnaround times.
• Maintain audit statistics and prepare monthly reports.
• Coach claims team and provide guidance on audits.
• Assist with SOC, carrier, vendor, and employer audits.
• Support system upgrade testing.
• Handle refunds, voids, and stop payments.

Skills

Medical coding

Attention to detail

Problem solving

Communication skills

MS Excel

MS Word

Judgement & decision making

Teamwork

Independent work

Education

HS/GED

Associate degree

Tools

MS Excel

MS Word

Job description

Highmark Inc. is seeking a claims professional to ensure accurate processing and audit compliance across medical, dental, vision, FSA, and HRA claims. You will review plan documents, monitor audits, and coach staff to meet service levels.

The role requires 5 years of claims processing experience, strong CPT/HCPCS/ICD coding, and solid communication skills. You will collaborate with cross-functional teams and support system upgrades while ensuring high-quality outcomes.