Senior Claims Audit & Training Specialist

Highmark Health; Montpelier (VT); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. in Montpelier, VT seeks a claims auditor to ensure audits align with internal procedures and plan documents. You will monitor audit workflows, record results, and help train junior staff to improve accuracy and speed.

The role requires five years of experience with medical, dental, vision, FSA and HRA claims, plus strong CPT/HCPCS/ICD coding knowledge and excellent written and verbal communication skills. This is a production environment role with high attention to detail.

Qualifications

• Five years prior medical, dental, vision, FSA and HRA claims processing experience.
• HS/GED required; Associate degree preferred.
• Comprehensive CPT, HCPCS, ICD9 and ICD10 coding knowledge.
• Strong attention to detail with organizational skills.
• Excellent problem solving and communication abilities.

Responsibilities

• Ensure all claims are handled per internal procedures and plan documents.
• Monitor audits to meet strict turnaround time and quality standards.
• Record results in the audit tool and assist with training sessions.
• Conduct one-on-one coaching with the claims team, especially trainees.
• Provide guidance on questions related to claims processing.
• Assist with system upgrade testing and specialized audits as needed.

Skills

CPT coding

HCPCS coding

ICD9/ICD10 coding

Attention to detail

Problem solving

Verbal & written communication

Judgment

Teamwork

Education

HS/GED

Associate Degree

Tools

MS Excel

MS Word

Job description

Highmark Inc. in Montpelier, VT seeks a claims auditor to ensure audits align with internal procedures and plan documents. You will monitor audit workflows, record results, and help train junior staff to improve accuracy and speed.

The role requires five years of experience with medical, dental, vision, FSA and HRA claims, plus strong CPT/HCPCS/ICD coding knowledge and excellent written and verbal communication skills. This is a production environment role with high attention to detail.