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Claims Auditor Jobs (NOW HIRING)

Moda Health

Lead Medical Claims Auditor I

Milwaukie, OR

$20.88 - $23.49/hr

Minimum of 2 years of experience as a Claims Auditor. * Excellent reading, verbal and written communication skills and ability to interact professionally, patiently, and courteously. * Strong ...

Risk Strategies

Specific Stop Loss Claims Auditor

$51K - $75K/yr

The Health Claims Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files to ensure compliance, accuracy, and adherence to company procedures and regulatory requirements.

Tokio Marine HCC

Specific Claims Auditor

$40K - $88K/yr

Set claims reserves and adjusts as needed. Keep the reserves current. * Authorize checks for amount of liability and communicate to TPA/client reasons for any amounts not covered by excess policy.

UCLA Health

Claims Quality Auditor

Los Angeles, CA · On-site

$31.51 - $62.64/hr

The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the auditor. You will review claims (paid, pending, and denied) for accuracy, appropriate application ...

Risk Strategies

Health Claims Stop Loss Auditor

$51K - $75K/yr

The Health ClaimsStop Loss Claims Auditor conducts detailed audits of high-complexity claims files to ensure compliance, accuracy, and adherence to company procedures and regulatory requirements.

Parkland Health

Performs claims data analysis and presents results and recommendations to the department leadership ... Coordinates with the Nurse Auditor for clinical consultations or account referrals when necessary.

Conduent, Inc.

Pharmacy Claims Auditor CPhT

Miami, FL · Hybrid

$57K/yr

Pharmacy Claims Auditor CPhT Do you have a CPhT certification? Would you like to audit pharmacy claims for accuracy? About the Role Conduent Payment Integrity Solutions performs in depth pharmacy ...

Conduent, Inc.

Pharmacy Claims Auditor CPhT

Miami, FL · On-site

$57K/yr

Pharmacy Claims Auditor CPhT Do you have a CPhT certification? Would you like to audit pharmacy claims for accuracy? About the Role Conduent Payment Integrity Solutions performs in depth pharmacy ...

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How much do claims auditor jobs pay per hour?

As of Aug 14, 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 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 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 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.

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.
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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 91% Full Time, 7% 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 Property (Temporary/Project Based)

Alan Gray LLC

Boston, MA • On-site

$40 - $60/hr

Temporary

Re-posted 17 days ago

Job description

Alan Gray LLC is a leading audit and advisory firm with over 30 years of excellence in providing a range of services to insurance-industry clients. Our goal is to help our clients realize significant bottom-line savings. Our experienced team is committed to staying current with the latest industry information and advances in technology in order to provide excellent service to our clients.

Please note - This is an evergreen posting to generate a pipeline of qualified candidates to contact as projects ramp up. As a consulting firm, we are continually looking for talent to support projects and engagements.

Claims Auditor:

The claim auditor will review and provide comments on property claim files as part of ongoing best practices audits. The auditor will apply his or her experience and training, along with specific account instructions and pertinent regulations, to evaluate all aspects of claim handling, including coverage determinations, negotiations, internal and external communications, and the notation and documentation contained in the files under review.

Key Objectives:

  • Investigative and evaluate property claims, including complex and catastrophic claims, as part of claim audits.
  • Review, analyze and provide opinions as to claim handling practices of claims handled by Third Parties.
  • Review regulatory compliance and proper handling of moderate to complex claims.
  • Demonstrate proficiency in claim file management and customer service.
  • Depending on experience and ability, the position may require project management responsibilities where the individual will direct and oversee audits and manage assigned auditors.

Qualifications:

  • Strong knowledge of property claim handling.
  • Minimum of 5 years of insurance claim experience.
  • Strong organizational, file management, and time management skills.
  • Attention to detail; ability to prioritize.
  • Demonstrated focus on quality and continuous improvement.