Senior Claims Audit & Training Specialist

Highmark Health; Des Moines (IA); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. is seeking an experienced claims auditor to ensure compliance with internal procedures, review plan wording, and render accurate audit results. The role emphasizes coaching staff and supporting audit processes across the team.

Required are 5 years of medical/dental/vision claims processing experience; HS/GED; CPT/HCPCS/ICD9/ICD10 coding knowledge; strong communication and Excel/Word basics. This position involves a salary range and comprehensive benefits.

Qualifications

• 5 years prior medical dental, vision, FSA and HRA claims processing experience. Preferred: Associate Degree
• HS/GED required
• Associate Degree preferred
• Comprehensive understanding of CPT, HCPCS, ICD9 and ICD10 medical coding
• Strong attention to detail and organizational skills
• Excellent problem solving with ability to work in a fast-paced production environment
• Excellent communication skills both verbal and written
• Ability to use judgement to make sound decisions referencing all resources
• Ability to work independently and as part of a team

Responsibilities

• Ensure claims audits follow internal procedures and review plan wording for each employer group
• Monitor audit workflow to meet turnaround time targets
• Record results in the audit tool and assist in monthly reporting
• Provide coaching and guidance to the claims team
• Assist with system upgrade testing
• Handle other duties as assigned

Skills

Medical coding

Auditing

Communication

Independent work

Team collaboration

Problem solving

Attention to detail

Education

HS/GED

Associate Degree

Tools

MS Excel

MS Word

Job description

Highmark Inc. is seeking an experienced claims auditor to ensure compliance with internal procedures, review plan wording, and render accurate audit results. The role emphasizes coaching staff and supporting audit processes across the team.

Required are 5 years of medical/dental/vision claims processing experience; HS/GED; CPT/HCPCS/ICD9/ICD10 coding knowledge; strong communication and Excel/Word basics. This position involves a salary range and comprehensive benefits.