{"schemaVersion":"jobsearcher.job.v1","id":"9c90e778b4c1df3ebee11c5d","url":"https://jobsearcher.com/jobs/9c90e778b4c1df3ebee11c5d","canonicalUrl":"https://jobsearcher.com/jobs/9c90e778b4c1df3ebee11c5d","title":"Quality Coordinator","description":"Company Highmark Inc.Job Description JOB SUMMARYThis job conducts audit review of finalized claims, adjustments and customer service activities. Evaluating the accuracy of claims inquiries and adjustments against BCBSA and FEP guidelines, government regulations, corporate and departmental policies and procedures, contractual guidelines, benefit booklets and any other related requirements applicable.ESSENTIAL RESPONSIBILITIES Audits – conduct independent review of transaction to evaluateAccuracy of claims adjudication process as stipulated by the group contractsAccuracy and completeness of service responses to member and provider inquiries.Accuracy of enrollment processes and procedures for member applications and group benefit change forms. The review process includesValidating the actual outcome of a finalized claim against the expected outcome and paymentValidating the action taken to resolve an inquiry against the issues/concerns expressed by the inquirer andValidating the information contained in all membership and group benefit files against the source documents received by the Plan. Audit Documentation – research, acquire and maintain current and reliable reference documentation required to conduct each audit review in order to support findings and satisfy potential audits by BCBSA, FEP, etc. Resolution of Audit Findings – accurate and complete reporting of audit findings Other duties as assigned or requested.EDUCATIONRequiredHigh School Diploma/GEDSubstitutionsNonePreferredNoneEXPERIENCERequiredOSCAR Adjustment experienceExperience in operations’ core systems (ICIS, INSINQ, ECS, OSCAR and MEDCO) as an operational userPreferredTraining in Quality AssuranceLICENSES or CERTIFICATIONSRequiredNoneSKILLSAttention to detailLanguage (Other Than English)NoneTravel Requirement0% - 25%PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONSPosition TypeOffice-basedTeaches / trains others regularlyOccasionallyTravel regularly from the office to various work sites or from site-to-siteRarelyWorks primarily out-of-the office selling products/services (sales employees)NeverPhysical work site requiredYesLifting up to 10 poundsConstantlyLifting 10 to 25 poundsOccasionallyLifting 25 to 50 poundsNeverDisclaimer The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum$19.66Pay Range Maximum$27.42Base 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.We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.orgCalifornia Consumer Privacy Act Employees, Contractors, and Applicants Notice","company":"Highmark","rawCompany":"highmark","city":"Denver","state":"CO","isRemote":false,"isActive":false,"createdAt":"2026-08-19T12:14:13.115Z","occupations":[{"code":"19-4099.01","title":"Quality Control Analysts","slug":"quality-control-analysts"},{"code":"11-3051.01","title":"Quality Control Systems Managers","slug":"quality-control-systems-managers"},{"code":"51-9061.00","title":"Inspectors, Testers, Sorters, Samplers, and Weighers","slug":"inspectors-testers-sorters-samplers-and-weighers"}],"industries":[{"code":"524298","title":"All Other Insurance Related Activities","slug":"all-other-insurance-related-activities"},{"code":"524114","title":"Direct Health and Medical Insurance Carriers","slug":"direct-health-and-medical-insurance-carriers"},{"code":"524292","title":"Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds","slug":"pharmacy-benefit-management-and-other-third-party-administration-of-insurance-and-pension-funds"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Quality Coordinator","description":"Company Highmark Inc.Job Description JOB SUMMARYThis job conducts audit review of finalized claims, adjustments and customer service activities. Evaluating the accuracy of claims inquiries and adjustments against BCBSA and FEP guidelines, government regulations, corporate and departmental policies and procedures, contractual guidelines, benefit booklets and any other related requirements applicable.ESSENTIAL RESPONSIBILITIES Audits – conduct independent review of transaction to evaluateAccuracy of claims adjudication process as stipulated by the group contractsAccuracy and completeness of service responses to member and provider inquiries.Accuracy of enrollment processes and procedures for member applications and group benefit change forms. The review process includesValidating the actual outcome of a finalized claim against the expected outcome and paymentValidating the action taken to resolve an inquiry against the issues/concerns expressed by the inquirer andValidating the information contained in all membership and group benefit files against the source documents received by the Plan. Audit Documentation – research, acquire and maintain current and reliable reference documentation required to conduct each audit review in order to support findings and satisfy potential audits by BCBSA, FEP, etc. Resolution of Audit Findings – accurate and complete reporting of audit findings Other duties as assigned or requested.EDUCATIONRequiredHigh School Diploma/GEDSubstitutionsNonePreferredNoneEXPERIENCERequiredOSCAR Adjustment experienceExperience in operations’ core systems (ICIS, INSINQ, ECS, OSCAR and MEDCO) as an operational userPreferredTraining in Quality AssuranceLICENSES or CERTIFICATIONSRequiredNoneSKILLSAttention to detailLanguage (Other Than English)NoneTravel Requirement0% - 25%PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONSPosition TypeOffice-basedTeaches / trains others regularlyOccasionallyTravel regularly from the office to various work sites or from site-to-siteRarelyWorks primarily out-of-the office selling products/services (sales employees)NeverPhysical work site requiredYesLifting up to 10 poundsConstantlyLifting 10 to 25 poundsOccasionallyLifting 25 to 50 poundsNeverDisclaimer The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum$19.66Pay Range Maximum$27.42Base 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.We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.orgCalifornia Consumer Privacy Act Employees, Contractors, and Applicants Notice","datePosted":"2026-08-19T12:14:13.115Z","dateModified":"2026-08-19T12:14:13.115Z","hiringOrganization":{"@type":"Organization","name":"Highmark","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Denver","addressRegion":"CO","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"9c90e778b4c1df3ebee11c5d"},"url":"https://jobsearcher.com/jobs/9c90e778b4c1df3ebee11c5d"}}