Claims Auditor

We are seeking a detail-oriented and experienced Claims Auditor to join our team. This position requires a strong understanding of medical billing, claims processing, and auditing procedures. This is a six month contract.Key ResponsibilitiesReview processed claims for accuracy before payment release.Audit claims for potential fraud, waste, and abuse.Conduct daily, focus, and random audits of claim payments and provider/member calls as outlined in department policies.Log, distribute, and report audit results to the Claims Manager, including daily productivity and statistical reports.Ensure compliance with Summary Plan Descriptions, Federal and State Mandates, and Board of Trustees' updates.Monitor and resolve claims reports, including Held Audits and Prepayment audits, to ensure adherence to department standards.Facilitate and track corrections of claims adjudication errors.Maintain and update the Claims Manual Processing Guide for department use.Communicate process improvement suggestions to enhance departmental efficiency.Test and audit claims payments for accuracy pre- and post-payment.Perform other duties as assigned by the Claims Manager or Administrative Manager.Qualifications and SkillsHigh School diploma or GED required.Minimum of 2 years (5 years preferred) of experience in health claims auditing or complex claims processing within the health insurance industry.Proficiency in Word, Excel, and medical terminology.Strong knowledge of ICD-10, CPT, and HCPCS codes, as well as general healthcare payer billing procedures.Exceptional organizational skills and the ability to manage multiple tasks and deadlines.Strong written and verbal communication skills.Ability to work independently and collaboratively as part of a team.Experience with proprietary software applications is a plus.Why Join Us?Contribute to a vital role in ensuring the accuracy and integrity of healthcare claims.Be part of a collaborative and professional team.Opportunities for professional growth and development.How to ApplyIf you meet the qualifications and are passionate about claims auditing, we encourage you to apply! Email me at for any questions. All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county, to the extent our customers requirea background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.

Created: 2025-01-16