Senior Claims Audit & Quality Lead

Highmark Health; Juneau (AK); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Health is seeking an experienced claims auditor to ensure accurate processing of medical, dental, vision, FSA and HRA claims. You will review plan documents, monitor audits, and coach staff to maintain quality and timely turnaround.

Requirements include 5 years of claims processing experience, CPT/HCPCS/ICD coding knowledge, and strong communication skills. The role involves working in a fast-paced environment with adherence to regulatory guidelines.

Qualifications

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

Responsibilities

• Handle claims audits following internal procedures and plan documents.
• Monitor audit workflows to ensure timely turnaround.
• Record results and support monthly reporting.
• Provide coaching and guidance to junior staff.
• Assist with specialized audits for SOC, carrier, and vendor reviews.
• Maintain knowledge of benefits, regulations and system upgrades.
• Respond to complex claim situations with sound decisions.

Skills

Medical claims processing

CPT/HCPCS/ICD9/ICD10

Attention to detail

Communication skills

MS Excel

Independent worker

Education

HS/GED

Associate Degree

Tools

MS Word

Job description

Highmark Health is seeking an experienced claims auditor to ensure accurate processing of medical, dental, vision, FSA and HRA claims. You will review plan documents, monitor audits, and coach staff to maintain quality and timely turnaround.

Requirements include 5 years of claims processing experience, CPT/HCPCS/ICD coding knowledge, and strong communication skills. The role involves working in a fast-paced environment with adherence to regulatory guidelines.