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Auditor, Claims BCI
Highmark HealthClaims auditor reviewing medical, dental, vision, FSA, and HRA claims for Highmark Health. Auditing accuracy, coaching claims staff, and supporting complex claims decisions.
Posted 9/4/2026full-timeRemote • Alabama, Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming • 🇺🇸 United StatesMid-LevelSenior💰 $22 - $33 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims processing, including medical, dental, vision, FSA, and HRA claims, while ensuring compliance with state regulations and federal guidelines. Proficient in auditing, training, and providing guidance to team members in a fast-paced environment.
Highest-signal resume keywords
Claims Processing ExperienceCPT, HCPCS, ICD-9, ICD-10 CodingAudit Workflow ManagementTraining and Coaching SkillsAttention to Detail
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingCPT CodingHCPCS CodingICD-9 CodingICD-10 CodingAudit ManagementRefund ProcessingVoid ProcessingStop-Payment ProcessingSystem Upgrade Testing
Soft Skills
Attention to DetailOrganizational SkillsProblem-Solving AbilityVerbal CommunicationWritten Communication
Tools & Technologies
PC NavigationMS ExcelMS Word
Industry Keywords
Medical ClaimsDental ClaimsVision ClaimsFSAHRAState RegulationsFederal Guidelines
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Highmark Health Website LinkedIn All 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. Auditor, Claims BCI Job not on LinkedIn 🔥 11 minutes ago 🏈 Alabama, Alaska, +44 more states – Remote 💵 $21 - $32 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor 👻 Ghost score 0% Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 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 Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Risk Adjustment, HCC Coder, Auditor 🔥 3 hours ago e4health 501 - 1000 💼 Consulting ⚖️ Legal 📦 Logistics Website LinkedIn All Job Openings HCC Auditor validating risk-adjustment codes and medical records for e4health healthcare clients. Reporting audit results and training coders and providers remotely. 🇺🇸 United States – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor A/R Auditor – Project Hire 🔥 4 hours ago nimble solutions 1001 - 5000 💼 Consulting 📦 Logistics 🛡️ Insurance Website LinkedIn All Job Openings Remote A/R Auditor reviewing medical claims and EOBs for errors at Nimble Solutions. Transitioning into insurance collections and denied-claim appeals. 🇺🇸 United States – Remote ⏰ Full Time 🟢 Junior 🟡 Mid-level 🔎 Auditor 🚫👨🎓 No degree required 🦅 H1B Visa Sponsor Nurse Auditor 🔥 18 hours ago Ensemble Health Partners 5001 - 10000 💼 Consulting 🛡️ Insurance 📦 Logistics Website LinkedIn All Job Openings Nurse Auditor validating clinical documentation, coding, and billing accuracy. Supporting Ensemble’s technology-enabled revenue cycle management for health systems. 🇺🇸 United States – Remote 💰 Private Equity Round on 2022-03 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor Environment, Health and Safety Auditor 🔥 20 hours ago BSI 1001 - 5000 💼 Consulting 🏗️ Construction 📦 Logistics Website LinkedIn All Job Openings EHS Auditor conducting ISO 9001, 14001, and 45001 audits for BSI, a global business improvement and standards company. Managing client portfolios, reporting results, and supporting assessor development. 🇺🇸 United States – Remote 💵 $95.2k - $142.8k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor Revenue Cycle Compliance Auditor – Resident Trust 🔥 22 hours ago Tutera Senior Living and Health Care 1001 - 5000 🍽️ Food & Beverage 🏨 Hospitality 📦 Logistics Website LinkedIn All Job Openings Revenue Cycle Compliance Auditor safeguarding resident funds for Tutera Senior Living & Health Care. Auditing PCC and RFMS transactions, reconciliations, documentation, and compliance controls. 🇺🇸 United States – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor View More Auditor Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Remote jobs Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources About us Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass Resume Review AI Apply Copilot OpenClaw job finder API docs Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs