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Claim Auditor Jobs (NOW HIRING)

RoadVantage

Claim Auditor

Austin, TX · On-site

Claim Auditor Reports to: Claims Training Supervisor Department: Claims/Operations Direct Reports: No Exempt Status: Non-Exempt Job Purpose The Claim Auditor is responsible for conducting weekly ...

DMC Insurance, Inc.

Claims Auditor

Indianapolis, IN · On-site

The Claim Auditor is responsible for auditing internal and external claim files for excess reporting compliance, reserving adequacy, quality assurance, adequate resolution plan. This is a position ...

RiteChoice Rx

Claims Auditor

The ideal candidate is someone who can review claim details carefully, communicate findings clearly, and support a culture of compliance across the organization. Pharmacy auditing, medical billing ...

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How much do claim auditor jobs pay per hour?

As of Jul 21, 2026, the average hourly pay for claim auditor in the United States is $26.83, according to ZipRecruiter salary data. Most workers in this role earn between $19.71 and $29.81 per hour, depending on experience, location, and employer.

How to become a medical claims auditor?

To become a medical claims auditor, typically a high school diploma or equivalent is required, with many employers preferring candidates with a bachelor's degree in health administration, accounting, or a related field. Relevant experience in healthcare billing, coding, or insurance claims is beneficial, and obtaining certifications such as the Certified Professional Coder (CPC) or Certified Claims Auditor (CCA) can enhance job prospects. Strong attention to detail, knowledge of medical coding systems like ICD and CPT, and familiarity with claims processing software are important for success in this role.

What are claim auditors?

Claim auditors are professionals who review and evaluate insurance claims to ensure their accuracy, legitimacy, and compliance with company policies and regulations. They analyze documentation, verify billing codes, and check for errors or fraud in submitted claims. The goal of a claim auditor is to minimize financial losses for insurers and ensure that policyholders and providers receive fair and proper payments. Claim auditors may work for insurance companies, third-party administrators, or healthcare organizations. Their work helps maintain the integrity of the claims process and supports efficient operations.

Is an auditor a high paying job?

Claim auditors are typically paid competitive salaries that vary based on experience, location, and industry. Entry-level positions may offer moderate pay, while experienced auditors or those with specialized certifications can earn higher salaries, making it a financially rewarding career for many professionals.

Is claims processing a stressful job?

Claims processing can be a stressful job for claim auditors due to tight deadlines, high accuracy requirements, and the need to review complex documentation. Attention to detail, strong organizational skills, and the ability to handle workload pressure are important for success in this role.

What is the difference between Claim Auditor vs Claims Processor?

AspectClaim AuditorClaims Processor
Required CredentialsTypically requires a certification in claims auditing or insuranceOften requires basic insurance or claims processing training
Work EnvironmentOffice setting, reviewing claims for accuracy and complianceOffice or call center, entering and processing claims data
Employer & IndustryInsurance companies, third-party administratorsInsurance companies, healthcare providers

Claim Auditors focus on reviewing and verifying claims for accuracy and compliance, often requiring specialized certifications. Claims Processors handle the entry and initial processing of claims, typically with less emphasis on auditing skills. Both roles are essential in the insurance industry but differ in responsibilities and required credentials.

What is a claims auditor?

A claims auditor reviews insurance claims to ensure accuracy, compliance with policies, and proper payment. They analyze claim documentation, identify discrepancies, and may use auditing software or tools to detect fraud or errors, often working in insurance or healthcare industries.

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

To thrive as a Claim Auditor, you need a strong understanding of insurance policies, claim processing procedures, and attention to detail, typically supported by a degree in business, finance, or a related field. Familiarity with claims management systems, auditing software, and sometimes certifications like Certified Professional Medical Auditor (CPMA) are commonly required. Analytical thinking, integrity, and effective communication are crucial soft skills for investigating claims and collaborating with stakeholders. These skills ensure accurate claim evaluation, fraud prevention, and compliance with regulatory standards.

What are some common challenges faced by Claim Auditors and how can they be addressed?

Claim Auditors often encounter challenges such as reviewing large volumes of complex claim files, interpreting varying policy guidelines, and ensuring compliance with both internal and external regulations. Staying organized and detail-oriented is crucial, as is keeping up-to-date with changes in policies or industry regulations. Effective communication with claims adjusters and other departments helps resolve discrepancies quickly and ensures accurate claim processing. Joining regular training sessions and leveraging audit software tools can also help streamline workflows and reduce errors.
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Claim Auditor jobs near you
Infographic showing various Claim Auditor job openings in the United States as of July 2026, with employment types broken down into 89% Full Time, 8% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 6% Hybrid, and 7% Remote job distribution, with an average salary of $55,805 per year, or $26.8 per hour.
Claim Auditor

Claim Auditor

RoadVantage

Austin, TX • On-site

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Claim Auditor
Job Description

Title: Claim Auditor
Reports to: Claims Training Supervisor
Department: Claims/Operations
Direct Reports: No
Exempt Status: Non-Exempt
Job Purpose
The Claim Auditor is responsible for conducting weekly comprehensive audits for examiners to ensure claims processes are being followed as outlined by the department and provide direct feedback, support, and necessary coaching based on results.
Essential Job Functions
  • Perform detailed audits of loss reports and call interactions for all examiners, identifying discrepancies, operational opportunities, and quality concerns
  • Identify, document, and communicate audit findings by preparing comprehensive reports for leadership, including key trends and call quality insights
  • Evaluate claim handling and call performance through a structured scoring system; document results and deliver clear, actionable feedback to employees verbally and/or in writing
  • Facilitate coaching sessions with examiners to ensure all quality and customer service standards across both claims processing and call handling
  • Work directly with the training team to create and develop ongoing training materials and skill refinement plans for the department based on audit and call QA results
  • Participate in calibration sessions with examiners and department leadership to ensure consistency in audit and call QA scoring
  • Track and analyze performance results for monthly scorecards, department KPIs, and call quality metrics
  • Provides support operations which includes inbound call handling and claim processing
  • Serve as a mentor and subject matter resource for the department, offering guidance on claim handling and customer interactions
  • Maintain a continual knowledge of products and services to ensure compliance with all regulations
  • Identify root causes of recurring issues within claims processes and propose effective solutions to management to mitigate risks
  • Perform other duties as assigned

Minimum Qualifications
  • Minimum 1-2 years of relevant experience in quality assurance or quality monitoring, within a call center environment
  • Minimum 1-2 years customer service call center environment strongly preferred
  • Proficiency in desktop MS applications – Outlook, Excel, PowerPoint
  • Claims Adjusters License (preferred)
  • Effective presentation, planning, and oral and written communication skills
  • Works well independently and effectively manages their time to meet all established deadlines
  • Must be highly flexible, and able to handle and manage a high degree of change
  • Demonstrates a high commitment to quality and has strong attention to detail
  • Strong customer service acumen with hyper-focus on the customer experience
  • Able to evaluate employee progress to ensure that the business needs of the department are being met.
  • Maintain high and consistent production level as assigned

The information contained herein is not intended to be an all-inclusive list of the duties and responsibilities of the job, nor are they intended to be an all-inclusive list of the skills and abilities required to do the job. Management may, at its discretion, assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons.

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