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Claims Quality Auditor Jobs (NOW HIRING)

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 ...

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.

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 ...

Corvel

Claims Quality Assurance

Dallas, TX · On-site

$70K - $116K/yr

The Claims Quality Assurance serves as the technical claims expert for the Claims Operations by auditing compliance with established CorVel, industry and carrier claim handling standards. The primary ...

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 ...

Corvel

Claims Quality Assurance

Dallas, TX · Remote

The Claims Quality Assurance serves as the technical claims expert for the Claims Operations by auditing compliance with established CorVel, industry and carrier claim handling standards. The primary ...

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 ...

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Claims Quality Auditor information

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How much do claims quality auditor jobs pay per hour?

As of Aug 18, 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 is a claims quality auditor?

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 skills and qualifications are needed to be a claims quality auditor?

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.

What challenges do claims quality auditors face and how can they be 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.

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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 August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, 4% Contract, and 1% Nights. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $55,805 per year, or $26.8 per hour.

Claims Quality Auditor

University of California - Los Angeles Health

Los Angeles, CA • On-site

$31.51 - $62.64/hr

Other

This job post has expired today. Applications are no longer accepted.

Job description

Description

Take on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health.

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 of benefits, authorization for services, contract interpretation, Division of Financial Responsibility (DOFR), and application/compliance with policies and procedures. You will:

  • Research over and under-payment inquiries/appeals
  • Compile and maintain statistical data consistent
  • Maintain departmental production and quality standards
Salary Range: $31.51 - $62.64Hourly
Qualifications

We're seeking a self-motivated, detail-oriented, deadline-driven individual with:

  • High school diploma, GED or equivalent
  • Four or more years of medical claims payment experience in an HMO environment
  • Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS
  • Understanding of Medicare Guidelines and COB
  • Knowledge of medical terminology
  • Experience in benefit determination and claims adjudication
  • Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM
  • Understanding of professional and facility reimbursement methodologies
  • Strong organizational skills
  • Computer proficiency with Microsoft Office
  • Knowledge of claims adjudication systems
  • Flexibility and adaptability

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