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Claims Quality Auditor Jobs (NOW HIRING)

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 ...

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

Auditor Clinical Validation DRG

$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 ...

Advantage Tech

Claims Specialist

Lees Summit, MO · Remote

$25/hr

... quality, call and claim auditing, compliance adherence, issue identification, and continuous improvement. This role provides subject matter expertise across medical and dental claims, claim ...

Advantage Tech

Claims Specialist

Kansas City, MO · On-site

... quality, call and claim auditing, compliance adherence, issue identification, and continuous improvement. This role provides subject matter expertise across medical and dental claims, claim ...

American Health Partners

Claims Auditor

Franklin, TN · Hybrid

Ensure regulatory compliance and overall quality and efficiency by utilizing strong working ... Proficient in processing/auditing claims for Medicare and Medicaid plans * Strong knowledge of CMS ...

New

Health Source MSO

Claims Auditor

Alhambra, CA · On-site

Claims Auditor will be responsible for auditing claims processed by Claims Examiners ... quality and productivity standards Maintain a minimum audit-accuracy rate Participate in special ...

American Health Partners

Claims Auditor

Franklin, TN · On-site

Ensure regulatory compliance and overall quality and efficiency by utilizing strong working ... Proficient in processing/auditing claims for Medicare and Medicaid plans * Strong knowledge of CMS ...

New

Quantix

Healthcare Claims Auditor

Ann Arbor, MI

... quality. Quantix ProTech continues to partner with the commercial sector for specialized IT ... Job Title: Healthcare Claims Auditor Location: Ann Arbor, MI Type: Contract Length: Through 12/22 ...

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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 12, 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.
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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, 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 Auditor

University Health - San Antonio

San Antonio, TX

Full-time

Re-posted 29 days ago

Job description

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 service delivered to our customers. Identifies processor and phone representative training needs that can be used to improve performance. Requires knowledge of claims processing for HCFA and UB92 for both commercial and Medicaid programs and knowledge of CFHP claims payment processing system, Amisys.

EDUCATION/EXPERIENCE
High school diploma or equivalency is required. Minimum of five years experience in insurance, medical or managed care environment including two years of claim processing experience required. Previous auditing and/or Amisys experience preferred.

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