Senior Medical Claims Auditor

Highmark Health; Dover (DE); On-site; USD 30,000 - 45,000; Full time

Job summary

Highmark Inc. is seeking a claims auditor with 5+ years of medical claims processing experience to ensure accurate auditing in line with CPT, HCPCS, ICD9 and ICD10 coding. You will monitor audits, document results, and train staff while maintaining high quality standards.

The role requires strong communication, problem solving, and the ability to work independently or as part of a team in a fast-paced environment. Prior experience with system upgrades and audits is a plus.

Qualifications

• Comprehensive understanding of CPT, HCPCS, ICD9 and ICD10 medical coding.
• Strong attention to details and 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 audit workflow to meet turnaround times and review performance.
• Maintain workload to meet quality and production standards for the auditing team.
• Document results in the audit tool and support training sessions for issues identified.
• Coach the claims team and provide guidance on audits and workflows.
• Assist with system upgrade testing and specialized audits as needed.

Skills

CPT/HCPCS/ICD9-ICD10 coding

Attention to detail

Problem solving

Communication skills

PC navigation

MS Excel

MS Word

Judgement

Independent & team work

Education

HS/GED

Associate Degree (preferred)

Tools

MS Excel

MS Word

Job description

Highmark Inc. is seeking a claims auditor with 5+ years of medical claims processing experience to ensure accurate auditing in line with CPT, HCPCS, ICD9 and ICD10 coding. You will monitor audits, document results, and train staff while maintaining high quality standards.

The role requires strong communication, problem solving, and the ability to work independently or as part of a team in a fast-paced environment. Prior experience with system upgrades and audits is a plus.