Senior Medical Claims Auditor

Highmark Health; Charleston (WV); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. is seeking a Claims Auditor to ensure audits adhere to internal procedures and plan documents. You will monitor workflows, record results, and partner with supervisors to train staff on identified issues.

Responsibilities include coaching the claims team, handling complex claim situations, and assisting with system upgrades and special audits as required. Strong communication and coding knowledge are essential.

Qualifications

• Comprehensive CPT/HCPCS/ICD9/ICD10 medical coding knowledge.
• Strong attention to detail and organizational skills.
• Excellent problem solving with the ability to work in a fast paced production environment.
• Excellent verbal and written communication skills.
• PC navigation skills for Professional work environment.
• Basic MS Excel and Word skills.

Responsibilities

• Ensure claims audits comply with internal procedures and plan documents.
• Monitor audit workflow to meet turnaround times and performance standards.
• Record audit results and assist in training sessions for issues identified by management.
• Provide coaching to the claims team, especially junior staff.
• Assist with system upgrade testing and special audits as needed.
• Liaise with clients and management to convey findings and recommendations.

Skills

Medical coding

Attention to detail

Problem solving

Communication skills

PC navigation

Teamwork

Education

HS/GED

Associate Degree

Tools

MS Excel

MS Word

Job description

Highmark Inc. is seeking a Claims Auditor to ensure audits adhere to internal procedures and plan documents. You will monitor workflows, record results, and partner with supervisors to train staff on identified issues.

Responsibilities include coaching the claims team, handling complex claim situations, and assisting with system upgrades and special audits as required. Strong communication and coding knowledge are essential.