Auditor Claims BCI Company Highmark Health

Federal Contractor Location Helena, MT

Date Posted 09/05/2026

Description Company Highmark Inc. Job Description Duties Note The following is not intended to be an exhaustive list of all duties required of this position. ADA 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 rmendation 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. E8. Maintain detailed knowledge of benefits, state regulations, federal guidelines and system upgrades. E9. Review and provide expertise to the claims team withplex claim situation/issues by using all resources to render a sound decision. E10. Utilize excellent written or verbalmunication skills to liaise with clients, management, peers and other areas within the organization E11. Manage the refund, void and stop payment process E12. Provide guidance to the claims team with questions on all aspects of claims processing. E13. Assist with system upgrade testing. N14. Handle other duties as assigned Education/Experience/Skills Requirements Required Education HS/GED Required Experience 5 years prior medical dental, vision, FSA and HRA claims processing experience. Preferred Associate Degree Required Knowledge/Skills 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 Excellentmunication 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 Required Licenses/Certifications Problem Solving Ability 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. Managerial/Supervisory Responsibilities Does this Position have Supervisory Responsibility? No Number of Emps Supervised Titles of Employees Supervised Financial/Budgetary Responsibilities Other Job Specifications External s Working Conditions/Physical Demands Pay Range Minimum $21.96 Pay Range Maximum $32.95 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may for certain locations based uponparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistancepleting the application process, please contact the email below. For amodation requests, please contact HR Services Online at HRServiceshighmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID J286268