Hiring: Auditor Claims BCI Company: Highmark Location: United States Job Posted Time: 2026-09-10 10:57:26 Target Skills & Keywords : CPT, Medical Coding, Microsoft Excel, Render, SOC About the job Experience: •5 years prior medical dental, vision, FSA and HRA claims processing experience. Preferred Associate Degree Required Skills: •Duties Note The following is not intended to be an exhaustive list of all duties required of this position. •E1. Ensure all claims are handled according to all internal operating and administrative procedures along with reviewing plan wording for each individual employer group, which should include the plan document, amendments, matrices and benefit summary. •E2. Monitor workflow of audits to ensure timely turnaround time. Identify the performance guarantee group’s audits to meet the strict guidelines for turnaround time. •E3. Maintain workload in accordance with the quality and production standards defined for the auditing team. •E4. Record results in the audit tool for monthly reporting. Partner with the supervisor to create and conduct training sessions for issues identified by the management team. •E5. Conduct one on one coaching with the claims team especially the trainee staff •E6. Provide recommendation for dollar authorization for claims team members based on audit stats and interaction with individual claim team members. •E7. Assist supervisor with specialized audits for the SOC process, carrier, vendor and employer audits as necessary. 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 •Demonstrated capacity to use judgement to make sound decisions referencing all available resources •Demonstrated capacity to work independently and also as part of a team •Demonstrated capacity to research and seek assistance through all available resources, to ensure resolution on claim audits. Must be able to multi-task and follow up at appropriate intervals. Raise concerns to the management team on situations and/or issues in a timely manner. Compensation: •5 years prior medical dental, vision, FSA and HRA claims processing experience Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!