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Claims Auditor Jobs (NOW HIRING)

mycenters

Claims Auditor

Staten Island, NY

Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims. Collaborates with other Health plan departments and Management to ensure claims are processed in accordance ...

Elevance Health

Claims Auditor Lead

Atlanta, GA · 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 ...

Elevance Health

Claims Auditor Lead

Miami, FL · 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 ...

Relation Insurance

Claims Auditor - TPA

Tulsa, OK · On-site

WHAT WE'RE LOOKING FOR The Claims Auditor ensures claims are processed in accordance with contractual, regulatory, and internal performance requirements. The individual in this role supports quality ...

Elevance Health

Claims Auditor Lead

Indianapolis, IN · 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 ...

Elevance Health

Claims Auditor Lead

Tampa, FL · 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 ...

Relationinsurance

Claims Auditor - TPA

WHAT WE'RE LOOKING FOR The Claims Auditor ensures claims are processed in accordance with contractual, regulatory, and internal performance requirements. The individual in this role supports quality ...

Elevance Health

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 ...

Elevance Health

Claims Auditor Lead

Nashville, TN · 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 ...

Elevance Health

Claims Auditor Lead

Atlanta, GA · On-site

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

Relationinsurance

Claims Auditor - TPA

Tulsa, OK

WHAT WE'RE LOOKING FOR The Claims Auditor ensures claims are processed in accordance with contractual, regulatory, and internal performance requirements. The individual in this role supports quality ...

UHS

Claims Auditor/Trainer

Reno, NV

The Healthcare Claims Auditor/Trainer is responsible for ensuring the accuracy, compliance, and quality of claims processing across all lines of business. This role performs detailed audits, develops ...

UHS

Claims Auditor/Trainer

Reno, NV · On-site

$26.65 - $38/hr

The Healthcare Claims Auditor/Trainer is responsible for ensuring the accuracy, compliance, and quality of claims processing across all lines of business. This role performs detailed audits, develops ...

Ourhrconnect

$72K - $94K/yr

Develop new and review old stop loss claim forms. Assist with internal auditing of claims auditors, and training of claims auditors. To Qualify for This Position, You'll Need the Following:

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How much do claims auditor jobs pay per hour?

As of Sep 4, 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 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?

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.

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Claims Auditor jobs near you
Infographic showing various Claims Auditor job openings in the United States as of August 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 85% Physical, 4% Hybrid, and 11% Remote job distribution, with an average salary of $55,805 per year, or $26.8 per hour.

Claims Auditor

mycenters

Staten Island, NY

Full-time

Re-posted 11 days ago

Job description

Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with opportunities for cross-training and education, CPHL is the place for a fulfilling long-term career.
JOB SUMMARY:

 

Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims. Collaborates with other Health plan departments and Management to ensure claims are processed in accordance with Federal, State and CPHL established guidelines and/or policies and procedures. Provides feedback or suggestions to enhance current processes and/or systems; works under general supervision.
 

PRIMARY RESPONSIBILITIES: 

 

  • Conducts monthly audits of CPHL claims utilizing CPHL guidelines, policies and procedures or any other regulatory requirements.
  • Follow defined audit processes and keep up to date with departmental changes in conducting quality reviews.
  • Ensure the consistent use of current codes, correct information, documentation and departmental procedures by monitoring their use and identifying any deficiencies.
  • Prepare summaries for management of quality review results, including basic analysis of identified trends.
  • Analyzes audit results to recommend system or procedural changes to increase claim accuracy and/or identify opportunities for workflow enhancements.
  • Evaluates Prospective Payment System (PPS) (e.g. APC, DRG, etc.) grouping and pricing information.
  • Meets individual and departmental standards in regards to quality and productivity.
  • Strong organizational, analytical and writing skills.
  • Excellent verbal and communication skills.
  • Maintain good working relationships within and outside of the department.
  • Provides expertise and assistance relative to provider billing and payment guidelines consistent with CPHL policies and procedures and State or CMS guidelines.
  • Performs other duties and special projects as assigned and directed.

EDUCATION AND EXPERIENCE:

 

Education

 

Required: BA/BS degree in a financial field or equivalent healthcare experience   

Preferred:   

 

 

Type of Experience                                          

Required:   2+ years of claim processing experience with a Medicaid/Medicare Health Plan.

Preferred:   Experience in health insurance product environment.


Specific Technical Skills

Required:    Proficiency with MS applications, including but not limited to Word, Excel, Outlook

Certifications/Licensure:

Required:    n/a

            

Knowledge and Skills:

  • Effective presentation skills
  • Excellent verbal and written communication skills
  • Must be able to participate in meetings with all levels of management within the organization
  • Detail oriented, excellent follow up
  • Ability to multi-task in a fast paced environment
  • Must be service oriented, quick learner, team player
  • Appreciation of cultural diversity and sensitivity toward target population

Preferred:

SCOPE INFORMATION

# Direct Reports:      n/a                 

           

PHYSICAL REQUIREMENTS:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification.  They should not be construed as an exhaustive list of all responsibilities, duties and skills required.

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