Claims Auditor Lead
Wilmington, DE · 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 ...
Claims Auditor Lead
Wilmington, DE · 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 ...
Claims Auditor Lead
Wilmington, DE · Hybrid
Claims Auditor Lead 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 ...
Claims Auditor Lead
Wilmington, DE · Hybrid
Claims Auditor Lead 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 ...
Coding and Billing Auditor
Dover, DE · On-site
$53K - $81K/yr
Auditing experience preferred ... Significant experience coding professional claims in a medical office-based setting * Experience ...
Coding and Billing Auditor
Dover, DE · On-site
$53K - $81K/yr
Auditing experience preferred ... Significant experience coding professional claims in a medical office-based setting * Experience ...
Coding and Billing Auditor
Dover, DE · On-site
$53K - $81K/yr
Auditing experience preferred ... Significant experience coding professional claims in a medical office-based setting * Experience ...
Coding and Billing Auditor
Dover, DE · On-site
$53K - $81K/yr
Auditing experience preferred ... Significant experience coding professional claims in a medical office-based setting * Experience ...
Certified Professional Coder - Billing and Auditing (S)
Dover, DE · On-site
$50K - $80K/yr
Seeking a certified professional coder with significant experience in coding professional claims in ... Five (5) years in Inpatient / Outpatient coding and auditing experience. Company Description ...
Quick apply
Certified Professional Coder - Billing and Auditing (S)
Dover, DE · On-site
$50K - $80K/yr
Seeking a certified professional coder with significant experience in coding professional claims in ... Five (5) years in Inpatient / Outpatient coding and auditing experience. Company Description ...
Unemployment Insurance Quality Control Manager
Wilmington, DE · On-site
$60 - $75/hr
Direct the intensive review of randomly selected weekly claims to ensure the integrity of the ... Three years experience in auditing financial records and documents in accordance with Generally ...
Unemployment Insurance Quality Control Manager
Wilmington, DE · On-site
$60 - $75/hr
Direct the intensive review of randomly selected weekly claims to ensure the integrity of the ... Three years experience in auditing financial records and documents in accordance with Generally ...
Medical Biller/Certified Coder
Dover, DE · On-site
$18.75 - $24/hr
... claims submissions to a completed and paid A/R. Receive encounters from EMR or other means of ... auditing and providing training as needed. 8. Identifies and verifies documentation and coding ...
Medical Biller/Certified Coder
Dover, DE · On-site
$18.75 - $24/hr
... claims submissions to a completed and paid A/R. Receive encounters from EMR or other means of ... auditing and providing training as needed. 8. Identifies and verifies documentation and coding ...
Medical Biller/Certified Coder
Dover, DE · On-site
$18.75 - $24/hr
... claims submissions to a completed and paid A/R. Receive encounters from EMR or other means of ... auditing and providing training as needed. 8. Identifies and verifies documentation and coding ...
Medical Biller/Certified Coder
Dover, DE · On-site
$18.75 - $24/hr
... claims submissions to a completed and paid A/R. Receive encounters from EMR or other means of ... auditing and providing training as needed. 8. Identifies and verifies documentation and coding ...
Medical Biller/Certified Coder
Dover, DE · On-site
$18.75 - $24/hr
... claims submissions to a completed and paid A/R. Receive encounters from EMR or other means of ... auditing and providing training as needed. 8. Identifies and verifies documentation and coding ...
Medical Biller/Certified Coder
Dover, DE · On-site
$18.75 - $24/hr
... claims submissions to a completed and paid A/R. Receive encounters from EMR or other means of ... auditing and providing training as needed. 8. Identifies and verifies documentation and coding ...
Medical Biller/Certified Coder
Dover, DE · On-site
$18.75 - $24/hr
... claims submissions to a completed and paid A/R. Receive encounters from EMR or other means of ... auditing and providing training as needed. 8. Identifies and verifies documentation and coding ...
Medical Biller/Certified Coder
Dover, DE · On-site
$18.75 - $24/hr
... claims submissions to a completed and paid A/R. Receive encounters from EMR or other means of ... auditing and providing training as needed. 8. Identifies and verifies documentation and coding ...
Medical Biller/Certified Coder
Dover, DE · On-site
$18.75 - $24/hr
... claims submissions to a completed and paid A/R. Receive encounters from EMR or other means of ... auditing and providing training as needed. 8. Identifies and verifies documentation and coding ...
Medical Biller/Certified Coder
Dover, DE · On-site
$18.75 - $24/hr
... claims submissions to a completed and paid A/R. Receive encounters from EMR or other means of ... auditing and providing training as needed. 8. Identifies and verifies documentation and coding ...
Risk Manager
Wilmington, DE · On-site
... claims; and provides ongoing training and guidance to team members. The Risk Manager leads loss ... auditing and/or investigations. An equivalent combination of education and experience may be ...
Quick apply
Risk Manager
Wilmington, DE · On-site
... claims; and provides ongoing training and guidance to team members. The Risk Manager leads loss ... auditing and/or investigations. An equivalent combination of education and experience may be ...
Fiscal Associate II
Dover, DE · On-site
$19.24/hr
Job duties include but not limited to auditing expense documents, maintaining spreadsheets ... Reviews forms and source documents such as bills, receipts, invoices, claims, or service contracts ...
New
Fiscal Associate II
Dover, DE · On-site
$19.24/hr
Job duties include but not limited to auditing expense documents, maintaining spreadsheets ... Reviews forms and source documents such as bills, receipts, invoices, claims, or service contracts ...
New
Inventory Logistics Lead
Wilmington, DE · On-site
$55 - $75/hr
Postal Service/UPS/ Federal Express insurance claims, in a manner that assures the highest level of ... Collaborate with Internal Auditors on investigations and compliance audits. * Work with the IBM ...
Inventory Logistics Lead
Wilmington, DE · On-site
$55 - $75/hr
Postal Service/UPS/ Federal Express insurance claims, in a manner that assures the highest level of ... Collaborate with Internal Auditors on investigations and compliance audits. * Work with the IBM ...
Fiscal Associate II
Dover, DE · On-site
$19.24/hr
Job duties include but not limited to auditing expense documents, maintaining spreadsheets ... claims, or service contracts to complete purchase orders; confirms accuracy, completeness, required ...
New
Fiscal Associate II
Dover, DE · On-site
$19.24/hr
Job duties include but not limited to auditing expense documents, maintaining spreadsheets ... claims, or service contracts to complete purchase orders; confirms accuracy, completeness, required ...
New
Principal Research Strategist & Academic Indexing Director
Wilmington, DE · Remote
$100 - $1.0K/day
In an era saturated with generic digital noise and unverified claims, this partner leads our ... Proprietary Knowledge Auditing & IP Extraction: Conducting structured diagnostic interviews to ...
New
Quick apply
Principal Research Strategist & Academic Indexing Director
Wilmington, DE · Remote
$100 - $1.0K/day
In an era saturated with generic digital noise and unverified claims, this partner leads our ... Proprietary Knowledge Auditing & IP Extraction: Conducting structured diagnostic interviews to ...
New
Supervisory Internal Revenue Agent (Temporary Not To Exceed, May Be Extended Up To 5 Years)
Georgetown, DE · On-site
$125K/yr
... auditing work that required 1) knowledge of and skill in applying professional accounting ... Experience developing or reviewing technical recommendations, examination and claims determinations ...
Supervisory Internal Revenue Agent (Temporary Not To Exceed, May Be Extended Up To 5 Years)
Georgetown, DE · On-site
$125K/yr
... auditing work that required 1) knowledge of and skill in applying professional accounting ... Experience developing or reviewing technical recommendations, examination and claims determinations ...
Supervisory Internal Revenue Agent (Temporary Not To Exceed, May Be Extended Up To 5 Years)
Dover, DE · On-site
$125K/yr
... auditing work that required 1) knowledge of and skill in applying professional accounting ... Experience developing or reviewing technical recommendations, examination and claims determinations ...
Supervisory Internal Revenue Agent (Temporary Not To Exceed, May Be Extended Up To 5 Years)
Dover, DE · On-site
$125K/yr
... auditing work that required 1) knowledge of and skill in applying professional accounting ... Experience developing or reviewing technical recommendations, examination and claims determinations ...
Supervisory Internal Revenue Agent (Temporary Not To Exceed, May Be Extended Up To 5 Years)
Dover, DE · On-site
$125K/yr
... auditing work that required 1) knowledge of and skill in applying professional accounting ... Experience developing or reviewing technical recommendations, examination and claims determinations ...
Supervisory Internal Revenue Agent (Temporary Not To Exceed, May Be Extended Up To 5 Years)
Dover, DE · On-site
$125K/yr
... auditing work that required 1) knowledge of and skill in applying professional accounting ... Experience developing or reviewing technical recommendations, examination and claims determinations ...
Supervisory Internal Revenue Agent (Temporary Not To Exceed, May Be Extended Up To 5 Years)
Georgetown, DE · On-site
$125K/yr
... auditing work that required 1) knowledge of and skill in applying professional accounting ... Experience developing or reviewing technical recommendations, examination and claims determinations ...
Supervisory Internal Revenue Agent (Temporary Not To Exceed, May Be Extended Up To 5 Years)
Georgetown, DE · On-site
$125K/yr
... auditing work that required 1) knowledge of and skill in applying professional accounting ... Experience developing or reviewing technical recommendations, examination and claims determinations ...
Claims Auditor information
See Delaware salary details
$14.44 - $17.48
13% of jobs
$19.49 is the 25th percentile. Wages below this are outliers.
$17.48 - $20.52
18% of jobs
$20.52 - $23.56
15% of jobs
The median wage is $24.06 / hr.
$23.56 - $26.60
23% of jobs
$28.05 is the 75th percentile. Wages above this are outliers.
$26.60 - $29.64
13% of jobs
$29.64 - $32.68
5% of jobs
$32.68 - $35.72
1% of jobs
$35.72 - $38.76
3% of jobs
$38.76 - $41.80
5% of jobs
$41.80 - $44.84
1% of jobs
$44.84 - $47.88
2% of jobs
$14
$26
$47
How much do claims auditor jobs pay per hour?
As of Sep 6, 2026, the average hourly pay for claims auditor in Delaware is $26.85, according to ZipRecruiter salary data. Most workers in this role earn between $19.71 and $29.86 per hour, depending on experience, location, and employer.
What is a claims auditor?
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.
What does a claims auditor do?
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 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 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.
What is the difference between Claims Auditor vs Claims Processor?
| Aspect | Claims Auditor | Claims Processor |
|---|---|---|
| Required credentials | High school diploma or equivalent; some roles may require certifications in insurance or auditing | High school diploma or equivalent; on-the-job training often provided |
| Work environment | Office setting, reviewing claims for accuracy and compliance | Office setting, entering and processing insurance claims |
| Employer and industry usage | Insurance companies, third-party administrators, healthcare providers | Insurance 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.
More about Claims Auditor jobs
What are popular job titles related to Claims Auditor jobs in Delaware?
For Claims Auditor jobs in Delaware, the most frequently searched job titles are:
What job categories do people searching Claims Auditor jobs in Delaware look for?
The top searched job categories for Claims Auditor jobs in Delaware are:
What are popular job titles related to Claims Auditor jobs in DE?
For Claims Auditor jobs in DE, the most frequently searched job titles are:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 16 days ago
Elevance Health rating
7.5
Based on 354 frontline employees who took The Breakroom Quiz
219th of 315 rated insurance
Job description
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-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unlessaccommodationis granted as required by law.
The Claims Auditor Lead is responsible for processing high dollar claims within Service Operations. Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy. Serves as the subject matter expert for the unit.
Primary duties may include, but are not limited to:
Responsible for all team training including but not limited to new hires, cross training, new product and system enhancements.
Conducts audits for new hires and/or any team member learning a new skill.
Reviews, interprets and maintains records of quality and productivity for entire team.
Coaches, mentors and develops associates to ensure processes, guidelines and tools are utilized correctly.
Utilizes inventory management strategies to monitor priorities and ensure timely turnaround of all claims.
Responsible for creating, updating and maintaining departmental policy and claims auditor procedure manuals for accuracy.
Independently analyzes and makes decisions on complex claim audit issues.
Serves as subject matter expert on policy, workflow and technical questions.
Interfaces with all levels of support including but not limited to production support, medical management, provider /vendor contracting and other audit teams.
Partners with Management on complex claims reviews and resolution.
Responsible for reviewing and resolving shared mailbox issues.
Interprets contracts, prepares monthly reports, and attends meetings as subject matter expert when requested.
Manages projects as assigned and may work across different platforms or lines of business.
Reviews and responds to external audit requests.
Performs audit reviews of and may adjudicate complex high dollar claims by completing an end to end audit with final approval authority.
Minimum Requirements:
Requires a HS diploma or GED and a minimum of 6 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.
Preferred Requirements:
Proficiency in Microsoft Office Suite is highly preferred.
Commercial Claims experience is highly preferred
CI&W and WGS experience is highly preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
What Elevance Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Elevance Health
Sourced by ZipRecruiter
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Indianapolis, IN, US
Year founded
2004