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Claims Quality Auditor Jobs (NOW HIRING)

Cna

Claims Quality Review Consultant

Plano, TX · Hybrid

$54K - $103K/yr

Claims Quality Review Director Skills, Knowledge & Abilities ... Working knowledge of claim auditing and assigned line of business. Has the ability to analyze ...

CNA

$60 - $80/hr

Conduct Quality Assurance post-decision audits of insurance claims, in accordance with established ... Working knowledge of claim auditing and assigned line of business. * Has the ability to analyze ...

New

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 ...

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 ...

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 ...

University Health

Claims Auditor

San Antonio, TX · On-site

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 ...

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 ...

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All JobsFinance and Insurance JobsInsurance JobsInsurance Claims Specialist JobsClaims Quality Auditor Jobs

Claims Quality Auditor information

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How much do claims quality auditor jobs pay per hour?

As of Sep 7, 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.

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, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $55,805 per year, or $26.8 per hour.

Lead - Claims Operations

Astrana Health, Inc.

Monterey Park, CA • On-site

$27 - $32/hr

Full-time

Re-posted 5 days ago

Job description

Lead - Claims Operations
Department: Ops - Claims Ops
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Nita Alailefaleula
Compensation: $27.00 - $32.00 / hour
Description
We are currently seeking a highly motivated Lead - Claims Operations. This role will report to the Sr. Manager - Claims and enable us to continue to scale in the healthcare industry. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis.
What You'll Do
  • Monitor and review work of all Claims Quality, Appeals and Recovery staff to identify additional training needs and to ensure compliance with department quality/production standard
  • Provides performance feedback, as well as identifies developmental opportunities for Claims Quality, Appeals and Recovery staff
  • Monitor and review claims audit and transaction reports. Responsible for identifying claims error trends, implementing controls and changes that will minimize incorrect claims adjudication
  • Coordinate potential recovery efforts with Company Accounting and coordinate potential physician education opportunities with Company Physician Services
  • Work closely with other Company departments to ensure that all areas supporting claims meet appropriate claims quality goals
  • Ensures that all legal, regulatory and policy requirements are met by keeping informed of changes and by implementing necessary controls and/or programs to meet requirements
  • In collaboration with the Claims QA and Training Specialist, claims lead, responsible for ensuring that Claims Representatives have a thorough understanding of Company claims adjudication policies and procedures
  • Coordinate provider contract, health plan benefit/DOFR and system rules configuration testing with Business Applications Configuration team
  • Responsible for ensuring accurate reporting and timely submission of quarterly PDR timeliness reports
  • Work with the Company departments on implementing controls to minimize claims overpayments and identify physician education opportunities with Network Management
  • Work closely with other Company departments and specifically, the Claims QA and Training Specialist to communicate findings of recovery audits and to facilitate accurate adjudication of claims

Qualifications
  • Bachelor's degree in a relevant field or equivalent combination of education and progressively responsible experience
  • At least 5 years of claims experience working for either a Medical Group, IPA, MSO, or Health Plan
  • Advanced knowledge of and working experience with healthcare coding conventions such as ICD-10, CPT, and HCPCS
  • Thorough knowledge of medical claim processing procedures/systems, auditing, and a thorough understanding of claim protocols, industry standards and CMS regulations as it relates to claims payment and compliance
  • Knowledge of claims processing systems configuration and architecture, which will facilitate troubleshooting of claims transaction related issues

You're great for the role if:
  • Have EZ Cap knowledge

Environmental Job Requirements and Working Conditions
  • Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr, Monterey Park, CA 91754.
  • The target pay range for this role is between $27.00 - $32.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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