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Claim Auditor Jobs (NOW HIRING)

University Health

Claims Auditor

San Antonio, TX

Minimum of five years experience in insurance, medical or managed care environment including two years of claim processing experience required. Previous auditing and/or Amisys experience preferred.

University Health

Claims Auditor

San Antonio, TX · On-site

$19.55 - $29.75/hr

Minimum of five years experience in insurance, medical or managed care environment including two years of claim processing experience required. Previous auditing and/or Amisys experience preferred.

Independent Living Systems

Claims Auditor

Miami, FL · On-site

We are seeking a Claims Auditor to join our team at Independent Living Systems (ILS). ILS, along ... Analyze claim data and documentation to identify errors, inconsistencies, or potential fraud.

Claritev

DRG Clinical Auditor

Manhattan, NY · On-site

$80K - $85K/yr

Ensure claim reviews comply with HIPAA regulations, reimbursement policies, and federal/state ... The Senior Clinical Auditor applies deep expertise in healthcare coding, billing practices ...

Lancesoft

Audit - Dealer Auditor

Solon, OH · On-site

$48.27/hr

Perform audits of dealer warranty claim submissions through in-depth review of repair order ... Certified Internal Auditor, Certified Fraud Examiner, or PMP Certification Meet Your Recruiter ...

State of Oklahoma

Bankruptcy Auditor

Tulsa, OK · On-site

$64K/yr

If necessary, appear as a witness to testify as to the validity of a filed claim * Performs related ... Auditing methodology, techniques, and theories * Accounting principles and their application

Chubb

Claims/QC Auditor

Spokane Valley, WA

$38K - $65K/yr

Opening claims, assigning claim numbers, entering claims data into computer, etc. in a timely manner. * Checking losses to ensure that all supporting documentation is included and auditing claims ...

Stellantis

Capital Expenditure Audit Manager

Auburn Hills, MI · On-site

$98K - $129K/yr

This role provides both hands-on audit execution and day-to-day leadership of CapEx claim auditors, while serving as a subject-matter resource for complex, high-value, or disputed claims. The Manager ...

Lancesoft

Audit - Dealer Auditor

Minneapolis, MN · On-site

$48.27/hr

Job Title: Audit - Dealer Auditor Job Duration: 12+ Months Job Location & Type: Minneapolis, MN ... Perform audits of dealer warranty claim submissions through in-depth review of repair order ...

Consultative Search Group

Staff Auditor

Los Angeles, CA · On-site

$60K - $70K/yr

The Auditor will assist an audit lead in performing royalty compliance procedures of record labels ... claim schedules. * Communicate effectively with managers and auditees. * Conducting fieldwork ...

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How much do claim auditor jobs pay per hour?

As of Jun 30, 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.

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.

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 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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What cities are hiring for Claim Auditor jobs? Cities with the most Claim Auditor job openings:
What states have the most Claim Auditor jobs? States with the most job openings for Claim Auditor jobs include:
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Claim Auditor jobs near you
Infographic showing various Claim Auditor job openings in the United States as of June 2026, with employment types broken down into 1% As Needed, 88% Full Time, 8% Part Time, 1% Temporary, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $55,805 per year, or $26.8 per hour.
Claims Auditor- Remote

Claims Auditor- Remote

American Health Partners

Franklin, TN • Hybrid

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 21 days ago

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com. 

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! 

Benefits and Perks include:

  • Affordable Medical/Dental/Vision insurance options
  • Generous paid time-off program and paid holidays for full time staff
  • TeleMedicine 24/7/365 access to doctors
  • Optional short- and long-term disability plans
  • Employee Assistance Plan (EAP)
  • 401K retirement accounts
  • Employee Referral Bonus Program

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. 

  • Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
  • Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
  • Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
  • Work assigned claim projects to completion
  • Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
  • Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
  • Maintain production and quality standards as established by management
  • Participate in and support ad-hoc audits as needed
  • Other duties as assigned

JOB REQUIREMENTS:

  • Proficient in processing/auditing claims for Medicare and Medicaid plans
  • Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
  • Current experience with both Institutional and Professional claim payments
  • Knowledge of automated claims processing systems
  • Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.

REQUIRED QUALIFICATIONS:

  • Experience:
    • Two (2) years’ experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
    • Two (2) years’ experience in managed healthcare environment related to claims processing/audit
    • Two (2) years’ experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
    • Two (2) years’ experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
    • Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans
  • License/Certification(s):
    • Coding certification preferred

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

 This employer participates in E-Verify.

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About American Health Partners

Sourced by ZipRecruiter

American Health Partners is a family of six divisions staffed by outstanding employees who care deeply about others. Since our inception more than 45 years ago, we have been committed to bringing the highest quality healthcare available to our communities. That commitment continues to serve us, our patients, our customers and our partners well. Today, our diverse healthcare offerings serve nearly 12,000 individuals annually across multiple states. We operate in both urban and rural communities where people need healthcare close to home. By working closely with hospitals and other providers, we offer cost-effective options that give individuals greater control over their healthcare.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Franklin, TN, US

Year founded

1976

Social media

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