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Full Time Medical Claim Auditor Jobs (NOW HIRING)

CVS Health

Medical Claim Analyst

$18.50 - $38.82/hr

... Medical Claim Management policies and procedures to assist in ensuring claims are handled per ... Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is ...

RIT Solutions, Inc.

SQL Data Engineer

Atlanta, GA · On-site

$110K - $132K/yr

... team on their legacy claim auditing system. The role involves analyzing needs and ensuring ... the medical claim, member and provider data. • Should have worked on agile based projects. • ...

Moda Health

RN Hospital Claims Auditor

Portland, OR · On-site +1

$78K - $98K/yr

... or auditor. * Certified Professional Coder preferred. * 2 years' health insurance industry ... Perform pre and post pay medical claim reviews utilizing itemized hospital bills and other ...

RiteChoice Rx

Claims Auditor

Pharmacy auditing, medical billing auditing, or pharmacy technician experience is strongly ... This is a full-time position. * This position is remote, with occasional travel to the corporate ...

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Full Time Medical Claim Auditor information

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How much do full time medical claim auditor jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for full time medical claim auditor in the United States is $25.61, according to ZipRecruiter salary data. Most workers in this role earn between $17.79 and $24.52 per hour, depending on experience, location, and employer.

What is the difference between Full Time Medical Claim Auditor vs Medical Claims Processor?

AspectFull Time Medical Claim AuditorMedical Claims Processor
CredentialsCertification in medical billing or auditing (e.g., CPC, CCA)High school diploma or equivalent; on-the-job training
Work EnvironmentOffice setting, healthcare facilities, insurance companiesOffice environment, healthcare providers, insurance companies
Job FocusReviewing and verifying insurance claims for accuracy and complianceEntering and processing insurance claims for payment
Common UsageHealthcare insurance companies, billing departmentsHospitals, clinics, insurance providers

While both roles involve working with insurance claims, Full Time Medical Claim Auditors focus on reviewing and verifying claims for accuracy, whereas Medical Claims Processors handle the initial entry and processing of claims. The auditor role typically requires specialized certifications and a more analytical skill set, making it more focused on compliance and accuracy.

What cities are hiring for Full Time Medical Claim Auditor jobs?

Cities with the most Full Time Medical Claim Auditor job openings:

What are the most commonly searched types of Medical Claim Auditor jobs?

The most popular types of Medical Claim Auditor jobs are:

Full Time Medical Claim Auditor jobs near you

Claim Auditor I

Fort Worth, TX • On-site

Cook Children's Health Care System
Health Care and Social Assistance • 5 - 10K employees

7.9

Company rating: 7.9 out of 10

Based on 78 frontline employees who took The Breakroom Quiz

106th of 895 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about Cook Children's Health Care Systemexternal

Full-time

Re-posted 5 days ago

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.

Certification/Licensure:

About Us:

Cook Children's Health Plan

Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.

Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer.

Cook Children's Health Care System logo

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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