Auditor, Claims BCI

Job not on LinkedIn

🔥 23 hours ago

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – 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 0%

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.

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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 ensure timely turnaround • Maintain workload according to quality and production standards • Record audit results for monthly reporting • Partner with the supervisor to create and conduct training sessions • Coach claims team members, especially trainees • Recommend dollar authorization levels based on audit statistics and interactions with claim team members • Assist with specialized SOC, carrier, vendor, and employer audits • Maintain knowledge of benefits, state regulations, federal guidelines, and system upgrades • Review complex claims and provide expertise to the claims team • Liaise with clients, management, peers, and other organizational areas • Manage refund, void, and stop-payment processes • Provide guidance on claims-processing questions • Assist with system-upgrade testing • Handle other duties as assigned

🎯 Requirements

• High school diploma or GED • 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 ability in a fast-paced production environment • Excellent verbal and written communication skills • PC navigation skills for a professional work environment • Basic MS Excel • Basic MS Word • Ability to use judgment and available resources to make sound decisions • Ability to work independently and as part of a team