Senior Claims Auditor & Training Lead

Highmark; United States; On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. is seeking a claims auditing specialist to ensure accurate processing of medical/dental/vision/HRA/FSA claims. You will monitor audit workflows, coach junior staff, and provide expert guidance on complex claim situations across multiple plans.

Ideal candidates have extensive CPT/HCPCS/ICD9/ICD10 knowledge, strong problem solving and communication skills, and the ability to work both independently and within a team in a fast-paced environment.

Qualifications

• Comprehensive understanding of CPT, HCPCS, ICD9 and ICD10 medical coding
• Strong attention to details along with organizational skills
• Excellent problem solving with the ability to work in a fast paced production environment
• Excellent communication skills both verbal and written
• PC navigation skills for Professional work environment
• Basic MS Excel
• Basic MS Word
• Ability to use judgement to make sound decisions referencing all available resources
• Ability to work independently and also as part of a team

Responsibilities

• Ensure all claims are handled according to internal procedures and review plan wording for each employer group
• Monitor workflow of audits to ensure timely turnaround and meet guidelines
• Maintain workload in line with quality and production standards for auditing
• Record results in audit tool and report monthly; partner with supervisor to run training sessions
• Conduct one-on-one coaching with the claims team, including trainees
• Provide recommendations for dollar authorization based on audit stats
• Assist with specialized audits for SOC, carrier, vendor and employer audits
• Maintain knowledge of benefits, regulations and system upgrades
• Review complex claim situations to render sound decisions using all resources
• Liaise with clients, management, and peers with clear communication
• Manage refund, void and stop payment processes
• Guide claims team on all aspects of processing and system upgrades
• Handle other duties as assigned

Skills

CPT/HCPCS/ICD9/ICD10 coding

Attention to detail

Problem solving

Communication skills

PC navigation

MS Excel

MS Word

Decision making

Teamwork

Independent work

Education

HS/GED

Associate Degree (preferred)

Job description

Highmark Inc. is seeking a claims auditing specialist to ensure accurate processing of medical/dental/vision/HRA/FSA claims. You will monitor audit workflows, coach junior staff, and provide expert guidance on complex claim situations across multiple plans.

Ideal candidates have extensive CPT/HCPCS/ICD9/ICD10 knowledge, strong problem solving and communication skills, and the ability to work both independently and within a team in a fast-paced environment.