Jobs in the United States

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Added 14 mins ago
IT Service Desk Technician
OHM Advisors
Livonia, MI
Possesses talents and strengths in communication, conflict resolution, user education, problem solving, and self-education that allows them to excel in developing and maintaining strong…
Added 14 mins ago
IT Service Desk Technician
OHM Advisors
Ann Arbor, MI
Possesses talents and strengths in communication, conflict resolution, user education, problem solving, and self-education that allows them to excel in developing and maintaining strong…
Added 14 mins ago
J
Telecom Engineer
Jobgether
Remote, United States
- $73,000 to $95,000 USD / year
Associate degree in Information Technology or a related field is preferred.
Added 30 mins ago
Store Associate
Batteries Plus, LLC
Liberty, MO
Added 30 mins ago
Associate Account Manager, Commercial Employer Market Account Team Support - Express Scripts - Hybrid
The Cigna Group
St. Louis, MO
The Associate Account Manager (AAM) provides operational and data-focused support to the account teams of assigned clients and coalitions. The AAM manages reporting requests, submits and…
Added 41 mins ago
Nursing Supervisor (Nursing/Registered Nurse) - Behavioral Health/Inpatient Psych
UHS
GRAND FORKS, ND
State RN Certification/License required
Added 46 mins ago
On-Site Clinical Systems Analyst (RN)
UHS
AIKEN, SC
…of the clinical information system. This position provides problem tracking, resolution, on-going enhancement requests, active participation in system testing, workflow redesign, change…
Added 1 hour ago
BP
Area Chief of Staff Veterinarian
Banfield Pet Hospital
Henderson, NV
- $142,175 to $205,364 USD / year
If you are a current associate, you will need to apply through our internal career site. Please log into Workday and click on the Jobs Hub app or search for Browse Jobs.
Added 1 hour ago
BP
Area Chief of Staff Veterinarian
Banfield Pet Hospital
Las Vegas, NV
- $142,175 to $205,364 USD / year
If you are a current associate, you will need to apply through our internal career site. Please log into Workday and click on the Jobs Hub app or search for Browse Jobs.
Added 1 hour ago
BP
Area Chief of Staff Veterinarian
Banfield Pet Hospital
Las Vegas, NV
- $142,175 to $205,364 USD / year
If you are a current associate, you will need to apply through our internal career site. Please log into Workday and click on the Jobs Hub app or search for Browse Jobs.
Added 1 hour ago
CO
COMPENSATION SPECIALIST
City of Chicago
IL
- $78,768 USD / year
…respective Collective Bargaining Agreements (CBAs), Salary Resolution, City policies and applicable federal…
Added 1 hour ago
Retirement Client Service Associate
Charles Schwab
Westlake, TX
Excellent client service and problem resolution skills.
Added 1 hour ago
Creative & Branding Associate
ACC
Washington, DC
…priorities and scope comes from above, while execution and problem-solving on individual projects is largely self-directed. The role requires regular judgment calls around production…
Added 1 hour ago
Registered Nurse Medical-Surgical
AdventHealth
Burleson, TX
Proficiency in critical thinking/problem-solving skills, teamwork, tact, and conflict resolution, with organizational, multitasking, and prioritization skills.
Added 1 hour ago
Electrical Design Drafter
Trane Technologies
Haslet, TX
…closely with engineersand adds greater value by focusing on problem resolution, application of design drafting knowledge, and application of industry standards into our…
Added 1 hour ago
Mechanical Design Drafter
Trane Technologies
Haslet, TX
…closely with engineers and adds greater value by focusing on problem resolution, application of design drafting knowledge, and application of industry standards into our…
Added 1 hour ago
Laboratory Assistant
AdventHealth
Killeen, TX
Provides resolution to customer service issues within guidelines and supports education to clinical staff.
Added 1 hour ago
Manager Patient Access Services-ED-Texas Health Denton
Texas Health Resources
Denton, TX
Serves as a point of escalation and resolution of complex operational or customer service issues.
Added 1 hour ago
Customer Service Representative
REYNOLDS & REYNOLDS CO
College Station, TX
…and social groups after work - Volunteer programs through our Associate Foundation ** Job Responsibilities:** - Support customers in issue resolution - Communicate solutions clearly and…
Added 1 hour ago
Early Career Consult Program – Network Support Associate
Kyndryl
Frisco, TX
You must also be able to work at our Frisco office 5 days per week
Added 1 hour ago
Director of Critical Care ICU RN
HCA Healthcare
El Paso, TX
You will be responsible for twenty four-hour coverage and problem resolution to the services provided.
Added 1 hour ago
Principal Associate, Principal Extended Ops Associate - Card Delivery Operations (Client Facing)
Capital One
Plano, TX
As a Principal Associate for Card Delivery Operations , you are the operational engine bringing our business partners’ card products to reality. In this subject matter expert role, you will…
Added 1 hour ago
Tool Technician Lead - Night Shift
International
San Antonio, TX
Consistently models and coaches the priorities of SHE, Quality, Delivery and Cost, setting clear expectations for accountability, and problem prevention at the source.
Added 1 hour ago
SO
TR3 BUSINESS CONSULTANT JR - 11112026-82749
State of Tennessee
TN
- $4,098 USD / month
Graduation from an accredited college or university with an associate's degree.
Added 1 hour ago
Laboratory Supervisor
HCA Healthcare
San Antonio, TX
Technical Supervisor: Must have ONE of the following

Highmark Health

Auditor Claims BCI

Jefferson City, MO, United States

Apply on hiremo.mo.gov About employer

Applications open in a new tab.

Job details

Experience: 5 years prior medical dental, vision, FSA and HRA claims processing experience.
Posting language: English

Original job description

Summary

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 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.

E8. Maintain detailed knowledge of benefits, state regulations, federal guidelines and system upgrades.

E9. Review and provide expertise to the claims team with complex claim situation/issues by using all resources to render a sound decision.

E10. Utilize excellent written or verbal communication 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
Excellent communication 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 Contacts:

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 apply for certain locations based upon comparative 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.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice (https://dokumfe7mps0i.cloudfront.net/oms/4391/document/2026/1/doclib\_458575\_QLVK9\_1769448333304228022\_1769448333396/1769448333396.pdf)

Req ID: J286268

Apply on hiremo.mo.gov About employer

More about this job

Skills

Workflow
Auditing
Reporting
Organise training
Coaching
Communication skills
Claims processing
CPT
HCPCS
Medical coding
Organizational skills
Problem solving
Microsoft Excel
Microsoft Word
Work independently
Research

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Work requirements

Jobs in the United States