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Claims Auditor Jobs (NOW HIRING)

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 with its affiliated health plans known as Florida Community Care and Florida Complete Care, is ...

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 with its affiliated health plans known as Florida Community Care and Florida Complete Care, is ...

RiteChoice Rx

Claims Auditor

This role will support internal pharmacy claims auditing, help identify billing and documentation discrepancies, and work closely with pharmacy teams and operational leadership to strengthen audit ...

University Health

Claims Auditor

San Antonio, TX · On-site

$19.55 - $29.75/hr

POSITION SUMMARY/RESPONSIBILITIES Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of ...

University Health

Claims Auditor

San Antonio, TX · On-site

$19.55 - $29.75/hr

POSITION SUMMARY/RESPONSIBILITIES Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of ...

University Health

Claims Auditor

San Antonio, TX

$19.55 - $29.75/hr

POSITION SUMMARY/RESPONSIBILITIES Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of ...

University Health

Claims Auditor

San Antonio, TX

$19.55 - $29.75/hr

POSITION SUMMARY/RESPONSIBILITIES Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of ...

Health Source MSO

Claims Auditor

Alhambra, CA · On-site

Claims Auditor will be responsible for auditing claims processed by Claims Examiners. Responsibilities include, but not limited to: Maintain up-to-date knowledge of procedures for all ICD-10, CPT ...

Centivo

Claims Auditor

Buffalo, NY · Remote

$55K - $60K/yr

Centivo is seeking a Claims Auditor who will be responsible for conducting pre-payment, post-payment, and claims adjudication audits across multiple employer groups and product lines, including ...

Quantix

Healthcare Claims Auditor

Ann Arbor, MI

Job Title: Healthcare Claims Auditor Location: Ann Arbor, MI Type: Contract Length: Through 12/22/2016 Our client in the Ann Arbor, Michigan area is looking for Healthcare Claims Auditors to join ...

DMC Insurance, Inc.

Claims Auditor

Indianapolis, IN · On-site

We are seeking an experienced, highly motivated insurance professional to join our claims team. The Claim Auditor is responsible for auditing internal and external claim files for excess reporting ...

Elevance Health

Claims Auditor Lead

Atlanta, GA · Hybrid

Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 - 2days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work ...

Elevance Health

Claims Auditor Lead

Independence, OH · Hybrid

Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 - 2days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work ...

New

Elevance Health

Claims Auditor Lead

Midland, GA · Hybrid

Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 - 2days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work ...

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Claims Auditor information

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How much do claims auditor jobs pay per hour?

As of Jul 25, 2026, the average hourly pay for claims 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 Claims Auditors?

Claims Auditors are professionals responsible for reviewing and evaluating insurance claims to ensure accuracy, compliance with regulations, and adherence to company policies. They analyze claim files, verify documentation, and identify any discrepancies or potential fraud. Claims Auditors play a crucial role in minimizing errors, preventing financial losses, and maintaining the integrity of the claims process within insurance companies or healthcare organizations.

How to become a medical claims auditor?

To become a medical claims auditor, individuals typically need a high school diploma or equivalent, with many employers preferring candidates with a bachelor's degree in health administration, accounting, or a related field. Relevant experience in healthcare billing, insurance, or auditing is valuable, and certifications such as the Certified Medical Auditor (CMA) or Certified Professional Coder (CPC) can enhance job prospects. Strong attention to detail, knowledge of medical coding and billing procedures, and proficiency with auditing software are important for success in this role.

Is an auditor a high paying job?

Claims auditors typically earn a median salary that is competitive within the insurance and finance industries, with salaries varying based on experience, location, and certifications. Senior or specialized auditors can earn higher wages, and the role often requires attention to detail and knowledge of claims processing systems. Overall, it can be considered a well-paying profession compared to many entry-level jobs.

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

To thrive as a Claims Auditor, you need a strong understanding of insurance claims processes, compliance regulations, and attention to detail, typically supported by a degree in finance, business, or a related field. Familiarity with claims management systems, auditing software, and industry certifications like Certified Professional Medical Auditor (CPMA) can be highly beneficial. Analytical thinking, effective communication, and problem-solving skills help Claims Auditors identify discrepancies and collaborate across departments. These abilities are essential for ensuring accurate claims processing, minimizing errors, and maintaining organizational compliance.

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 Is the Job of a Claims Auditor?

As a claims auditor, your job is to review, process, and audit all claims, charges, and demands made of your company. Claims auditors usually handle requests for insurance benefits, but you can also work in schools or other industries that have frequent exposure to potential litigation. To accomplish your job, you review proposed claims, gather information, talk to witnesses, examine existing procedures, and otherwise try to determine the validity of an application. You may be asked to determine whether or not purchase orders are in line with policies, resolve problems with duplicate charges, and ensure the proper allocation of goods and services.

What is the difference between Claims Auditor vs Claims Processor?

AspectClaims AuditorClaims Processor
Required credentialsHigh school diploma or equivalent; some roles may require certifications in insurance or auditingHigh school diploma or equivalent; on-the-job training often provided
Work environmentOffice setting, reviewing claims for accuracy and complianceOffice setting, entering and processing insurance claims
Employer and industry usageInsurance companies, third-party administrators, healthcare providersInsurance companies, healthcare providers, claims processing centers

Claims Auditors focus on reviewing and verifying the accuracy of claims, ensuring compliance with policies and regulations. Claims Processors handle the initial entry and processing of claims, often working under supervision. While both roles are essential in the claims cycle, Claims Auditors have a more analytical and compliance-oriented role, whereas Claims Processors focus on data entry and claim submission.

Is claims a stressful job?

Claims auditors review insurance claims to ensure accuracy and compliance, which can involve tight deadlines and detailed analysis. The job can be stressful at times due to the need for accuracy, attention to detail, and handling complex cases, but workload and stress levels vary depending on the employer and workload management. Strong organizational skills and experience with claims processing systems can help manage stress effectively.

What are some common challenges faced by Claims Auditors, and how can they be managed effectively?

Claims Auditors often encounter challenges such as tight deadlines, large volumes of complex claims, and the need to stay updated on frequently changing regulations. Managing these challenges effectively requires strong organizational skills, attention to detail, and proactive communication with team members and other departments. Utilizing advanced auditing software and participating in ongoing training can also help Claims Auditors maintain accuracy and efficiency in their reviews.
More about Claims Auditor jobs
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What states have the most Claims Auditor jobs? States with the most job openings for Claims Auditor jobs include:
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What are popular job titles related to Claims Auditor jobs? For Claims Auditor jobs, the most frequently searched job titles are:
Claims Auditor jobs near you
Infographic showing various Claims 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.
Claims Auditor

Claims Auditor

Independent Living Systems

Miami, FL • On-site

Full-time

Posted 24 days ago

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Claims Auditor to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Claims Auditor plays an essential role in ensuring the accuracy, compliance, and integrity of health care claims within the organization. This position involves conducting thorough audits of submitted claims to verify adherence to regulatory standards, contractual obligations, and internal policies. The Claims Auditor will identify discrepancies, potential fraud, and areas for process improvement, thereby safeguarding the organization's financial health and reputation. By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors. Ultimately, this role supports the delivery of efficient and ethical services by maintaining transparent and accountable claims operations.

Minimum Qualifications:

  • Bachelor’s degree in Health Administration, or a related field.
  • At least 2 years of experience in claims auditing, health care compliance, or a similar role within the health care industry.
  • Strong knowledge of health care claims processes, insurance billing, and regulatory requirements such as HIPAA and CMS guidelines.
  • Proficiency in audit software and Microsoft Office Suite, particularly Excel for data analysis.
  • Relevant experience may substitute for the educational requirement on a year-for-year basis.

Preferred Qualifications:

  • Master’s degree in Health Administration, or a related field.
  • Certification such as Certified Internal Auditor (CIA), Certified Professional Coder (CPC), or Certified Healthcare Auditor (CHA).
  • Experience with claims management software.
  • Familiarity with fraud detection techniques and health care fraud prevention programs.
  • Demonstrated ability to lead audit projects or mentor junior auditors.

Responsibilities:

  • Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
  • Conduct detailed audits of healthcare claims to ensure accuracy, compliance with regulations, and adherence to organizational policies.
  • Analyze claim data and documentation to identify errors, inconsistencies, or potential fraud.
  • Prepare comprehensive audit reports with findings, recommendations, and corrective actions for management and stakeholders.
  • Collaborate with claims teams and healthcare providers to resolve discrepancies and drive process improvements.
  • Stay updated on healthcare regulations and industry best practices, while supporting internal and external audits with relevant documentation and insights.
  • Perform other duties as assigned.



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