Senior Claims Audit Specialist — Compliance & Training

Highmark Health; Lansing (MI); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. seeks an experienced claims auditor to ensure claims are processed per internal procedures and plan documents. You will monitor audits, maintain quality and timeliness, and coach the claims team to improve performance.

The role requires strong knowledge of CPT/HCPCS/ICD coding, excellent communication, and the ability to work independently or with a team in a fast-paced environment. This on-site position offers competitive compensation in Michigan.

Qualifications

• 5 years prior medical claims processing experience (medical/dental/vision/FSA/HRA).
• Proficient understanding of CPT, HCPCS, ICD9 and ICD10 coding.
• Strong attention to detail and organizational skills.
• Excellent verbal and written communication.
• Ability to use judgement and work independently or in a team.
• Proficient PC navigation in a professional environment.
• Basic MS Excel and Word proficiency.

Responsibilities

• Interpret and apply plan documents, amendments, and benefit summaries.
• Monitor audits to meet turnaround time and production standards.
• Record audit results and assist with monthly reporting.
• Provide coaching and training to claims staff, including trainees.
• Recommend dollar authorizations based on audit data.
• Support SOC, carrier, vendor, and employer audits as needed.
• Assist with system upgrade testing and issue resolution.
• Handle refunds, voids, and stop payments as required.
• Address complex claim issues using all available resources.

Skills

Coding knowledge CPT/HCPCS/ICD9/ICD10

Attention to detail

Problem solving

Communication skills

PC navigation

MS Excel

MS Word

Judgement

Teamwork

Education

High School Diploma or GED

Tools

MS Excel

MS Word

Job description

Highmark Inc. seeks an experienced claims auditor to ensure claims are processed per internal procedures and plan documents. You will monitor audits, maintain quality and timeliness, and coach the claims team to improve performance.

The role requires strong knowledge of CPT/HCPCS/ICD coding, excellent communication, and the ability to work independently or with a team in a fast-paced environment. This on-site position offers competitive compensation in Michigan.