Auditor, Claims

Job not on LinkedIn

🕒 September 4

🏈 Alabama, Alaska, +43 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $21 - $32 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 $5M Grant on 2021-05

Insurance • Consulting • Logistics

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Ensure claims are handled according to internal operating and administrative procedures and applicable employer-group plan wording • Monitor audit workflow and turnaround times, including performance guarantee group audits • Maintain workload according to auditing-team quality and production standards • Record audit results in the audit tool for monthly reporting • Partner with the supervisor to create and conduct training sessions on issues identified by management • Conduct one-on-one coaching with claims team members, especially trainees • Recommend dollar authorization levels for claims team members based on audit statistics and interactions • Assist the supervisor with specialized SOC, carrier, vendor and employer audits • Maintain detailed knowledge of benefits, state regulations, federal guidelines and system upgrades • Review complex claims and provide expertise to the claims team to support sound decisions • Liaise with clients, management, peers and other organizational areas • Manage refund, void and stop-payment processes • Provide guidance on all aspects of claims processing • Assist with system-upgrade testing • Handle other duties as assigned

🎯 Requirements

• High school diploma or GED required • 5 years of prior medical, dental, vision, FSA and HRA claims processing experience • Comprehensive understanding of CPT, HCPCS, ICD-9 and ICD-10 medical coding • Strong attention to detail and organizational skills • Excellent problem-solving abilities in a fast-paced production environment • Excellent verbal and written communication skills • PC navigation skills for a professional work environment • Basic MS Excel skills • Basic MS Word skills • Ability to use judgment and available resources to make sound decisions • Ability to work independently and as part of a team • Ability to research and seek assistance to resolve claim audits • Ability to multitask and follow up at appropriate intervals • Preferred: Associate Degree