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Claims Quality Auditor Jobs (NOW HIRING)

Cotiviti

Senior Auditor Quality - OPSP

$47 - $56/hr

Overview The Sr. Auditor, Quality Assurance position is responsible for ensuring that the audited claims meet quality standards necessary to generate high quality recoverable claims for the benefit ...

Cotiviti

Senior Auditor Quality - OPSP

$47 - $56/hr

Overview The Sr. Auditor, Quality Assurance position is responsible for ensuring that the audited claims meet quality standards necessary to generate high quality recoverable claims for the benefit ...

Independent Living Systems

Claims Auditor

Miami, FL · On-site

... quality of life and maximizing independence for all vulnerable populations. About the Role: The ... The Claims Auditor will identify discrepancies, potential fraud, and areas for process improvement ...

Independent Living Systems

Claims Auditor

Miami, FL · On-site

... quality of life and maximizing independence for all vulnerable populations. About the Role: The ... The Claims Auditor will identify discrepancies, potential fraud, and areas for process improvement ...

University Health

Claims Auditor

San Antonio, TX

$19.55 - $29.75/hr

POSITION SUMMARY/RESPONSIBILITIES Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of ...

University Health

Claims Auditor

San Antonio, TX · On-site

$19.55 - $29.75/hr

POSITION SUMMARY/RESPONSIBILITIES Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of ...

Cotiviti

$45.67/hr

... in claims auditing, quality assurance, or recovery auditing...ideally in a DRG / Clinical ... Validation Audit setting or a hospital environment. Coding/CDI Certification (at least one of the ...

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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 11, 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 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.

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.
More about Claims Quality Auditor jobs
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, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $55,805 per year, or $26.8 per hour.

Claims Quality Assurance Specialist - Property and Casualty Insurance - Base Salary to 100k/year - G

AllSearch Professional Staffing

Great Neck, NY • Hybrid

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

Job description

Claims Quality Assurance Specialist - Property and Casualty Insurance - Base Salary to 100k/year - Great Neck, NY

  • Our client, a large and growing insurance carrier, is seeking a Claims Quality Assurance Specialist who will work with departmental and team leaders to ensure claims operations comply with regulatory requirements, Fair Claims Settlement Practices, and industry best practices.
  • In this role, the Claims Quality Assurance Specialist will conduct pre- and post-payment claims audits to ensure claim accuracy, regulatory compliance, and adherence to company policies. The Claims Quality Assurance Specialist will analyze claim trends, identify root causes, recommend process improvements, support operational reporting and KPI development, and collaborate on claims system enhancements and cross-functional initiatives to improve efficiency and strengthen claims operations.

Responsibilities:

  • Conduct pre- and post-payment property and casualty claims audits to ensure claim accuracy, regulatory compliance, Fair Claims Settlement Practices, and adherence to company policies.
  • Review claims adjudication processes to identify errors, overpayments, operational trends, and compliance issues.
  • Perform root cause analysis and recommend improvements to claims processes, quality assurance standards, policies, procedures, and operational controls.
  • Support business expansion by implementing claims operational processes and compliance frameworks for new jurisdictions.
  • Develop, analyze, and report on claims quality metrics, operational KPIs, audit findings, and financial trends.
  • Collaborate with IT teams, business stakeholders, and external vendors on claims system enhancements, reporting initiatives, workflow improvements, and operational projects.
  • Support month-end operational activities and participate in cross-functional process improvement initiatives.

Qualifications:

  • 5+ years of progressive experience in Property & Casualty (P&C) claims.
  • Experience in claims auditing, claims quality assurance, claims compliance, or other compliance-focused claims roles.
  • Experience reviewing claim accuracy, claims adjudication, operational compliance, and regulatory requirements.
  • Experience performing root cause analysis and identifying process improvements within claims operations.
  • Strong proficiency with Microsoft Excel and data analysis.

Compensation:

  • Base salary in the 70k - 100k/year range
  • Medical (PPO), dental (PPO), vision (PPO), and life insurance covered 100% for employees and 50% for dependents.
  • 401k with 4% company match.
  • Paid vacation, sick time, and 13 paid holidays.
  • Hybrid Schedule after 90 days (3 Office Days / 2 Remote Days)

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