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Case Auditor Jobs (NOW HIRING)

Solis Health Plans

Grievance & Appeals Auditor I

Doral, FL · On-site

$55K - $65K/yr

The auditor evaluates case accuracy, procedural compliance, clinical and coverage determinations, and timeliness standards, while identifying opportunities for process improvement and risk mitigation.

New

Franchise Tax Board

Auditor

Sacramento, CA · On-site

$6.6K - $8.7K/mo

... the case. The incumbent will determine sample selections for examination, schedule field ... Auditor Classification: ASSOCIATE TAX AUDITOR, FRANCHISE TAX BOARD $6,646.00 - $8,740.00 New to ...

TEKsystems

Coding Auditor (CPC)

Baltimore, MD · Hybrid

$66K - $92K/yr

Medical Coding Auditor Hybrid (1 - 2 days in office per week) Baltimore, MD 21201 Compensation $66k ... case management system. • Support compliance investigations related to documentation, billing ...

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Case Auditor information

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$30.5K

$72.6K

$117.5K

How much do case auditor jobs pay per year?

As of Sep 6, 2026, the average yearly pay for case auditor in the United States is $72,633.00, according to ZipRecruiter salary data. Most workers in this role earn between $47,000.00 and $98,500.00 per year, depending on experience, location, and employer.

What is a case auditor?

Case Auditors are professionals who review and evaluate case files, records, or processes to ensure accuracy, compliance, and quality. They often work in legal, healthcare, insurance, or social services settings, where they check that cases are handled according to established standards and regulations. Their work helps identify errors, inefficiencies, or areas for improvement, contributing to better organizational performance. Case Auditors may also provide feedback or recommendations based on their findings to support quality assurance initiatives.

What are the key skills and qualifications needed to thrive as a case auditor, and why are they important?

To thrive as a Case Auditor, you need strong analytical skills, attention to detail, and a solid understanding of compliance regulations, often supported by a background in accounting, auditing, or a related field. Familiarity with audit management software, database systems, and relevant certifications such as Certified Internal Auditor (CIA) are typically required. Exceptional organizational, communication, and critical thinking skills help auditors effectively review cases and report findings. These competencies are crucial for ensuring accurate assessments, maintaining regulatory compliance, and supporting organizational integrity.

What are some common challenges faced by case auditors, and how can they be addressed?

Case Auditors often encounter challenges such as managing large caseloads, staying current with regulatory changes, and ensuring thorough documentation. Balancing accuracy with efficiency can be demanding, especially when deadlines are tight. To address these challenges, it's important to develop strong organizational skills, keep up with ongoing training, and maintain open communication with team members and stakeholders. Collaborating with colleagues and leveraging auditing tools can also help streamline workflows and ensure high-quality results.

What is the difference between Case Auditor vs Claims Processor?

AspectCase AuditorClaims Processor
Required CredentialsTypically requires a background in insurance, auditing, or related certificationsOften requires knowledge of claims processing systems and insurance policies
Work EnvironmentOffice setting, reviewing cases, auditing claims for accuracyOffice environment, processing insurance claims and data entry
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, healthcare providers, government agencies
Comparison Search IntentUnderstanding auditing roles in claims reviewLearning about claims processing tasks

The main difference between a Case Auditor and a Claims Processor lies in their focus. A Case Auditor reviews and verifies insurance claims for accuracy and compliance, often performing audits and quality checks. In contrast, a Claims Processor handles the initial processing of claims, entering data, and ensuring claims are correctly submitted. Both roles are essential in the insurance industry but serve different stages of the claims management process.

More about Case Auditor jobs

What job categories do people searching Case Auditor jobs look for?

The top searched job categories for Case Auditor jobs are:

Case Auditor jobs near you
Infographic showing various Case Auditor job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 79% Full Time, 17% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $72,633 per year, or $34.9 per hour.

Grievance & Appeals Auditor I

Solis Health Plans

Doral, FL • On-site

$55K - $65K/yr

Full-time

Posted 3 days ago

New

Job description

Job Summary

The Grievance and Appeals (G&A) Auditor is responsible for performing end-to-end audit of appeals and grievance cases. This role ensures compliance with applicable regulatory requirements, including standards established by the Centers for Medicare & Medicaid Services (CMS). The auditor evaluates case accuracy, procedural compliance, clinical and coverage determinations, and timeliness standards, while identifying opportunities for process improvement and risk mitigation.

Key Responsibilities

Primary duties may include, but are not limited to:

  • Conduct pre- and post-resolution audits of member appeals and grievance cases across Medicare Advantage and other managed care lines of business. 
  • Ensure compliance with CMS Medicare Advantage Appeals and Grievance regulations, internal policies, and regulatory timeframes. 
  • Review case files for accuracy and completeness, including: 
  • Member eligibility and benefit coverage 
  • Medical necessity determinations 
  • Clinical rationale and supporting documentation 
  • Benefit interpretation and plan policy application 
  • Provider and member communications 
  • Validate that appropriate clinical and administrative review levels were applied throughout the appeals and grievance lifecycle.
  • Assess adherence to CMS requirements for notices, including denial letters, appeal determinations, and grievance responses. 

Audit & Compliance Oversight

  • Identify procedural errors, compliance gaps, and documentation deficiencies. 
  • Evaluate timeliness of case resolution against regulatory standards. 
  • Document audit findings with clear rationale, regulatory citations, and impact assessments. 
  • Support audit readiness and regulatory examination activities. 

Documentation & Reporting

  • Prepare detailed audit reports outlining: 
  • Case review findings and decision accuracy 
  • Procedural and compliance deviations 
  • Financial, operational, or regulatory risk exposure 
  • Track audit outcomes to identify trends in appeals and grievance processing errors. 
  • Support reporting for compliance committees, regulatory audits, and internal quality initiatives. 

Quality Improvement & Support

  • Provide feedback to Grievance and Appeals teams regarding identified errors and improvement opportunities. 
  • Recommend corrective actions, training needs, and process enhancements. 
  • Identify systemic issues and collaborate with leadership, compliance, and operational teams to implement solutions. 
  • Escalate potential compliance risks or regulatory violations as appropriate. 

Collaboration & Communication

  • Partner with clinical reviewers, compliance officers, and operational leaders to resolve complex case issues. 
  • Communicate audit findings clearly to both technical and non-technical stakeholders.