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Disability Claim Auditor Jobs (NOW HIRING)

Cook Children's

Claim Auditor I

Fort Worth, TX · On-site

The Claim Auditor I is responsible for auditing behavioral and medical claims and ensuring quality ... or mental disability, pregnancy, protected veteran status, genetic information, or any other ...

Cook Children's

The Claim Auditor I is responsible for auditing behavioral and medical claims and ensuring quality ... or mental disability, pregnancy, protected veteran status, genetic information, or any other ...

Cook Children's

Claim Auditor I

Fort Worth, TX · On-site

The Claim Auditor I is responsible for auditing behavioral and medical claims and ensuring quality ... or mental disability, pregnancy, protected veteran status, genetic information, or any other ...

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How much do disability claim auditor jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for disability claim 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 disability claim auditor?

Disability Claim Auditors are professionals who review and assess disability insurance claims to ensure they are processed accurately and comply with company policies and legal regulations. They examine claim documents, medical records, and other supporting evidence to verify the validity of claims and identify potential fraud or errors. Their work helps maintain the integrity of disability insurance programs and ensures that claimants receive appropriate benefits. Disability Claim Auditors often collaborate with adjusters, medical professionals, and legal teams during the review process.

What are the key skills and qualifications needed to thrive as a disability claim auditor, and why are they important?

To thrive as a Disability Claim Auditor, you need strong analytical skills, attention to detail, and knowledge of insurance policies and disability regulations, typically supported by a relevant degree or experience in claims processing. Familiarity with claims management software, auditing tools, and regulatory compliance systems is crucial. Excellent communication, integrity, and organizational skills help auditors collaborate with teams and handle sensitive information effectively. These skills ensure accurate claim assessments, prevent fraud, and protect both the company and claimants.

What are some common challenges faced by disability claim auditors, and how can these be managed effectively?

Disability Claim Auditors often encounter challenges such as interpreting complex medical documentation, staying updated on regulatory changes, and balancing thoroughness with efficiency. Managing these challenges involves continuous professional development, collaborating closely with medical professionals and legal teams, and utilizing robust auditing software to streamline workflows. Strong communication skills and attention to detail are essential for accurately evaluating claims while maintaining compliance with industry standards.

What are popular job titles related to Disability Claim Auditor jobs?

For Disability Claim Auditor jobs, the most frequently searched job titles are:

Infographic showing various Disability Claim Auditor job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, 3% Contract, and 1% Nights. Highlights an 95% Physical, 2% Hybrid, and 3% Remote job distribution, with an average salary of $55,805 per year, or $26.8 per hour.

Claim Auditor I

Fort Worth, TX • On-site

Cook Children's
Health Care and Social Assistance • 5 - 10K employees
Learn more about Cook Children'sexternal

Full-time

Posted 13 days ago

Cook Children's Health Care System rating

7.9

Company rating: 7.9 out of 10

Based on 78 frontline employees who took The Breakroom Quiz

Job description

Location:

Calmont Operations Building

Department:

Reimbursement Analysis

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

The Claim Auditor I is responsible for auditing behavioral and medical claims and ensuring quality metrics are met by conducting post claims reviews on posted claims for Texas Medicaid and CHIP programs. The Claim Auditor I is responsible for auditing a set claim sampling on a monthly basis of routine to moderate complexity which includes paper and electronic claims submission. The Claim Auditor I ensures that claims payment integrity aligns with regulatory standards, timelines, business policy, provider and HHSC contracts, appropriate coding and system configuration. Audit reports may include UB-1450 and HCFA CMS 1500 claim forms not limited to behavioral health, physician, Institutions for Mental Disease, hospital outpatient and inpatient, and long term services and support claims. The Claim auditor is also responsible for pre-auditing high dollar claims to ensure claim payment is accurate before releasing the claim for payment. The Claim Auditor I is also responsible for communicating audit results to the Reimbursement and Analysis Manager in a structured report format within required timelines. Results of the audits are to be communicated to the Claims Department. The individual in this position performs all job functions in accordance with HIPPA and security rules as it relates to protected health information and has a thorough understanding of claims life cycle.

Additional Information:

The Claim Auditor I is responsible for auditing behavioral and medical claims and ensuring quality metrics are met by conducting post claims reviews on posted claims for Texas Medicaid and CHIP programs. The Claim Auditor I is responsible for auditing a set claim sampling on a monthly basis of routine to moderate complexity which includes paper and electronic claims submission. The Claim Auditor I ensures that claims payment integrity aligns with regulatory standards, timelines, business policy, provider and HHSC contracts, appropriate coding and system configuration. Audit reports may include UB-1450 and HCFA CMS 1500 claim forms not limited to behavioral health, physician, Institutions for Mental Disease, hospital outpatient and inpatient, and long term services and support claims. The Claim auditor is also responsible for pre-auditing high dollar claims to ensure claim payment is accurate before releasing the claim for payment. The Claim Auditor I is also responsible for communicating audit results to the Reimbursement and Analysis Manager in a structured report format within required timelines. Results of the audits are to be communicated to the Claims Department. The individual in this position performs all job functions in accordance with HIPPA and security rules as it relates to protected health information and has a thorough understanding of claims life cycle.

Education:

  • Associates degree required or a minimum of 5 years of claims/audit experience which includes experience with federal programs (Medicaid, CHIP) or in a health plan/payor environment preferred.

  • 7-10 years of medical claims processing, claim adjudication, coordination of benefit plan, medical terminology and coding.

  • Must have strong organizational skills, problem solving and decision-making skills.

  • Advanced knowledge of claim adjudication and benefit plan application for Medicaid and CHIP programs.

  • Microsoft Office skills including Word, Excel and Access.

  • Excellent customer service skills with ability to explain complicated benefit issues to staff and providers.


About Us:

Cook Children's is an equal opportunity employer. As such, Cook Children's offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

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About Cook Children's Health Care System

Sourced by ZipRecruiter

Cook Children's Health Care System, based in Fort Worth, Texas, operates in the healthcare industry with a primary focus on pediatric health services. Established in 1918, the system has been committed to improving the health of children through the prevention and treatment of childhood diseases. This integrated pediatric healthcare system includes a medical center, physician network, home health company, research institute, and a health plan. At the core of its operations is the mission to 'Improve the Health of Every Child' in its community, reflecting its commitment to providing quality care, research, education, and prevention and wellness services.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Fort Worth, TX, US

Year founded

1918

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