Highmark Health
Employer Industry: Healthcare Services
Why consider this job opportunity
Salary up to $35.18
Opportunity for career advancement and growth within the organization
Supportive and collaborative work environment
Chance to work on compliance and quality improvement initiatives
Involvement in training operational staff and acting as a subject matter expert
No travel required, allowing for work-life balance
What to Expect (Job Responsibilities)
Compile and analyze data related to complex adjusted claims
Conduct reviews of activities related to fraud and abuse to ensure compliance
Generate management reports detailing review findings and trends
Monitor and train quality and operational staff on processes
Identify and address potential fraudulent activities in claims processing
What is Required (Qualifications)
High School Diploma or GED
3-5 years of relevant experience in claims processing or quality assurance
Experience with Microsoft Office products
Detailed understanding of claims processing arrangements and performance standards
Strong verbal and written communication skills
How to Stand Out (Preferred Qualifications)
Bachelor’s Degree in a relevant field
Proficiency with reporting and analytical software tools
Experience with medical terminology and policy guidelines
Strong problem-solving and analytical skills
Background in process improvement methodologies
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.
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Why consider this job opportunity
Salary up to $35.18
Opportunity for career advancement and growth within the organization
Supportive and collaborative work environment
Chance to work on compliance and quality improvement initiatives
Involvement in training operational staff and acting as a subject matter expert
No travel required, allowing for work-life balance
What to Expect (Job Responsibilities)
Compile and analyze data related to complex adjusted claims
Conduct reviews of activities related to fraud and abuse to ensure compliance
Generate management reports detailing review findings and trends
Monitor and train quality and operational staff on processes
Identify and address potential fraudulent activities in claims processing
What is Required (Qualifications)
High School Diploma or GED
3-5 years of relevant experience in claims processing or quality assurance
Experience with Microsoft Office products
Detailed understanding of claims processing arrangements and performance standards
Strong verbal and written communication skills
How to Stand Out (Preferred Qualifications)
Bachelor’s Degree in a relevant field
Proficiency with reporting and analytical software tools
Experience with medical terminology and policy guidelines
Strong problem-solving and analytical skills
Background in process improvement methodologies
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.
#J-18808-Ljbffr