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Claims Quality Auditor Jobs (NOW HIRING)

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · On-site +1

Claims Quality Auditor| Remote Job Type: Full time Work Setup: Remote Reports to: Claims Supervisor Position Summary: The Claims Quality Auditor plays a key role in ensuring the accuracy, compliance ...

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 ...

ImagenetLLC

Claims Quality Auditor - Remote

Tampa, FL · Remote

Claims Quality Auditor| Remote Job Type: Full time Work Setup: Remote Reports to: Claims Supervisor Position Summary: The Claims Quality Auditor plays a key role in ensuring the accuracy, compliance ...

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · Remote

Claims Quality Auditor| Remote Job Type: Full time Work Setup: Remote Reports to: Claims Supervisor Position Summary: TheClaims Quality Auditor plays a key role in ensuring the accuracy, compliance ...

ImageNetLLC

Claims Quality Auditor - Remote

Tampa, FL · Remote

Claims Quality Auditor| Remote Job Type: Full time Work Setup: Remote Reports to: Claims Supervisor Position Summary: TheClaims Quality Auditor plays a key role in ensuring the accuracy, compliance ...

Parkland Health

Performs a detailed quality assurance of claims processed by the Third-Party Administrator (TPA ... Coordinates with the Nurse Auditor for clinical consultations or account referrals when necessary.

New

Chubb

Claims/QC Auditor

Spokane Valley, WA · On-site

$38K - $65K/yr

High School or GED required and at least 6 months as an Claims/QC Assistant at Rain and Hail or at least one year of previous underwriting or claims auditing experience or a baccalaureate degree.

Centivo

Claims Auditor

Buffalo, NY · Remote

$55K - $60K/yr

That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Centivo is seeking a Claims Auditor who will ...

Firstsource

Quality Auditor

- Auditor (HB & PB) Role Auditor - Hospital Billing (HB) & Professional Billing (PB) Role Summary ... Duplicate claims * Timely filing denials * Authorization issues * Provider/NPI-related denials

Firstsource

Quality Auditor

Louisville, KY · On-site

- Auditor (HB & PB) Role Auditor - Hospital Billing (HB) & Professional Billing (PB) Role Summary ... Duplicate claims * Timely filing denials * Authorization issues * Provider/NPI-related denials

Firstsource

Quality Auditor

- Auditor (HB & PB)Role Auditor - Hospital Billing (HB) & Professional Billing (PB) Role Summary ... Duplicate claims * Timely filing denials * Authorization issues * Provider/NPI-related denials

Amcor plc

Quality Auditor

Richmond, VA · On-site

... claims and monitoring supplier performance. • Effectively interacts with all departments ... auditors, and maintains quality system certification. • Maintains and follows all company ...

Amcor

Quality Auditor

Richmond, VA · On-site

Quality Manager Summary: The Quality Auditor serves as the lead quality authority for their ... Responsible for processing vendor claims and monitoring supplier performance. Effectively interacts ...

Curative HR LLC

Senior Auditor, Healthcare Claims

Austin, TX · Remote

$83K - $104K/yr

The Senior Auditor partners closely with Claims Operations, Configuration, Payment Integrity ... Claims Audit & Quality Oversight * Perform comprehensive audits of professional, institutional ...

Curative HR LLC

Senior Auditor, Healthcare Claims

Austin, TX · Remote

$83K - $104K/yr

The Senior Auditor partners closely with Claims Operations, Configuration, Payment Integrity ... Claims Audit & Quality Oversight * Perform comprehensive audits of professional, institutional ...

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How much do claims quality auditor jobs pay per hour?

As of Jul 26, 2026, the average hourly pay for claims quality 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 some common challenges faced by Claims Quality Auditors, and how can they be effectively managed?

Claims Quality Auditors often encounter challenges such as interpreting complex policy language, staying updated with evolving regulations, and managing large volumes of claims within tight deadlines. To manage these effectively, auditors should regularly participate in training sessions, use standardized auditing tools, and collaborate closely with claims adjusters and supervisors. Maintaining open communication with team members and leveraging technology for data analysis can also help ensure consistent and accurate audit results.

What is the difference between Claims Quality Auditor vs Claims Examiner?

AspectClaims Quality AuditorClaims Examiner
Primary RoleReviews and assesses the accuracy and compliance of claims to improve qualityProcesses and evaluates individual insurance claims for approval or denial
Required CredentialsTypically requires insurance or claims processing certifications, attention to detailOften requires similar certifications, with focus on claim evaluation skills
Work EnvironmentQuality assurance teams, office settings, audits of claims filesClaims departments, customer service environments, direct claim processing

While both roles involve claims, Claims Quality Auditors focus on reviewing and improving claim accuracy and compliance, whereas Claims Examiners handle the initial processing and decision-making on individual claims. Understanding these differences helps in choosing the right career path or job search focus.

What are Claims Quality Auditors?

Claims Quality Auditors are professionals who review and assess insurance claims to ensure they are processed accurately, efficiently, and in compliance with company standards and regulatory requirements. They analyze claim files, identify errors or discrepancies, and provide feedback or recommendations to claims adjusters and management. Their work helps maintain high-quality service, reduce fraudulent claims, and improve overall claims processing within insurance organizations.

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

To thrive as a Claims Quality Auditor, you need a solid understanding of insurance claims processes, regulatory compliance, and quality assurance practices, often supported by experience in claims handling or auditing. Familiarity with claims management systems, auditing software, and industry-specific certifications such as Certified Professional Coder (CPC) or Certified Claims Professional (CCP) is typically required. Strong attention to detail, analytical thinking, and effective communication help auditors identify discrepancies and provide actionable feedback. These skills ensure accuracy, reduce risk, and maintain compliance within insurance operations.
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What job categories do people searching Claims Quality Auditor jobs look for? The top searched job categories for Claims Quality Auditor jobs are:
Claims Quality Auditor jobs near you
Infographic showing various Claims Quality 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 Quality Auditor - Remote

Claims Quality Auditor - Remote

Imagenet

Tampa, FL • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 12 days ago

Job description

Claims Quality Auditor| Remote
Job Type: Full time
Work Setup: Remote
Reports to: Claims Supervisor
Position Summary:
The Claims Quality Auditor plays a key role in ensuring the accuracy, compliance, and effectiveness of claims processing and provider dispute resolution. The ideal candidate has hands on experience with EZCap, auditing claims, analyzing dispute claims and evaluating internal policies and regulatory requirements, with a particular focus on Medi-Cal and commercial health plans. This role is responsible to partners closely with cross-functional teams to drive continuous improvement and operational excellence.
Key Duties:
  • Perform detailed audits of denied, underpaid, and processed claims using EZCap to assess accuracy and compliance with provider contracts and regulatory guidelines.
  • Analyze provider disputes for patterns or recurring issues.
  • Identify root causes and work with relevant teams to implement corrective actions and process improvements.
  • Develop and track performance related to claims accuracy, turnaround time, and dispute resolution efficiency.
  • Conduct thorough root cause analyses on high-impact errors or escalations.
  • Support training initiatives by identifying knowledge gaps and assisting in the development of updated procedures and documentation based on audit results.
  • Ensure all reviewed processes align with applicable regulatory requirements. Participate in internal and external audits as needed.

Qualifications:
  • High school diploma or equivalent
  • At least 3-5 years of Quality Analyst in healthcare, TPA, or health plan settings/ healthcare claims or in a claims processing/adjudication environment
  • Hands-on experience with EZCap (strongly preferred)
  • Familiarity with Medi-Cal and Commercial insurance claim
  • Strong analytical and problem-solving skills
  • Excellent verbal and written communication
  • Attention to detail in documentation and compliance
  • Ability to manage multiple tasks and meet deadlines
  • Experience with other claim adjudication platforms and provider systems.
  • Familiarity with DHCS, DMHC, CMS dispute handling regulations.

What We Offer
  • Remote work offered
  • Equipment provided
  • Paid training to set you up for success
  • Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
  • Paid Time Off (PTO)
  • 7 paid holidays
  • A supportive team and a company that values internal growth

COMPANY OVERVIEW:
Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers.
The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.
Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.

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