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Health Insurance Auditor Jobs in Tennessee (NOW HIRING)

American Health Partners

Claims Auditor

Franklin, TN · Hybrid

Two (2) years' experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system * Two (2) years' experience in managed ...

American Health Partners

Claims Auditor

Franklin, TN · On-site

Two (2) years' experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system * Two (2) years' experience in managed ...

Under Canvas Inc.

Night Auditor

Pigeon Forge, TN · On-site

$14 - $18.50/hr

Night Auditor As a Night Auditor, you play a critical role in maintaining the camp operations ... Health Insurance * 401K (eligible if work hourly minimum as required by law) Heavily discounted ...

Acadia Healthcare

Staff Internal Auditor

Franklin, TN · On-site

Medical, dental, and vision insurance * Acadia Healthcare 401(k) plan * Paid vacation and sick time * Opportunity for growth that is second to none in the industry Your Job as a Staff Internal ...

Acadia Healthcare

Staff Internal Auditor

Franklin, TN · On-site

$65 - $90/hr

Medical, dental, and vision insurance * Acadia Healthcare 401(k) plan * Paid vacation and sick time * Opportunityfor growth that is second to none in the industry Your Job as a Staff Internal Auditor:

Acadia Healthcare

Staff Internal Auditor

Franklin, TN · On-site

Medical, dental, and vision insurance * Acadia Healthcare 401(k) plan * Paid vacation and sick time * Opportunity for growth that is second to none in the industry Your Job as a Staff Internal ...

Crowne Plaza Knoxville

Part-Time Night Auditor

Knoxville, TN · On-site

$14.25 - $19/hr

Health, dental, and vision insurance * Paid time off * 401(k) opportunities * Free on-site parking * Free employee meals * Employee discounts at IHG hotels worldwide * Opportunities for professional ...

Elevance Health

Claims Auditor Lead

Nashville, TN · Hybrid

Claims Auditor Lead Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 ... in healthcare or insurance sector); or any combination of education and experience which would ...

HCA Healthcare

DRG Validation Auditor

Chattanooga, TN · On-site

As a DRG Validation Auditor with Parallon you can be a part of an organization that is devoted to ... insurance, supplemental health protection plans, auto and home insurance, legal counseling ...

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All JobsHealth Insurance Auditor JobsHealth Insurance Auditor Jobs in Tennessee

Health Insurance Auditor information

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$16

$23

$41

How much do health insurance auditor jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for health insurance auditor in Tennessee is $23.81, according to ZipRecruiter salary data. Most workers in this role earn between $16.78 and $31.20 per hour, depending on experience, location, and employer.

What is a health insurance auditor?

A Health Insurance Auditor is a professional responsible for reviewing and evaluating healthcare claims, billing records, and insurance documents to ensure accuracy, compliance with regulations, and prevention of fraud. They analyze medical records and insurance policies to verify that services billed are medically necessary and properly documented. Their work helps healthcare organizations, insurance companies, and government agencies maintain financial integrity and comply with healthcare laws and standards.

What are the key skills and qualifications needed to thrive as a health insurance auditor?

To thrive as a Health Insurance Auditor, you need a solid understanding of healthcare billing, auditing procedures, and regulatory compliance, typically supported by a degree in healthcare administration, accounting, or a related field. Familiarity with claims management systems, electronic health records (EHRs), and certifications like Certified Professional Medical Auditor (CPMA) are common requirements. Attention to detail, analytical thinking, and effective communication are essential soft skills for identifying discrepancies and explaining audit findings. These skills and qualifications ensure accurate claims processing, regulatory compliance, and the prevention of fraud or financial loss for healthcare organizations and insurers.

What are some common challenges health insurance auditors face during claim reviews, and how can these be addressed?

Health Insurance Auditors often encounter challenges such as incomplete documentation, discrepancies between provider records and claims, and keeping up with frequently changing regulations. These issues can be addressed by maintaining up-to-date knowledge of industry standards, developing strong attention to detail, and fostering good communication with healthcare providers to clarify information. Additionally, utilizing audit management software and participating in regular training can help auditors stay organized and efficient in their reviews.

What is the difference between Health Insurance Auditor vs Claims Examiner?

AspectHealth Insurance AuditorClaims Examiner
CredentialsCertifications like CPC, CPC-H, or CIA often preferredCertifications like CPC or claims-specific training common
Work EnvironmentTypically in offices, performing audits on claims and recordsUsually in claims departments reviewing and processing claims
Industry UsageUsed across insurance companies, government agencies, and consulting firmsPrimarily employed by insurance companies and healthcare providers

Health Insurance Auditors focus on reviewing claims and records for accuracy and compliance, often conducting audits to prevent fraud and ensure proper billing. Claims Examiners process and review individual claims for payment. While both roles involve claims, auditors have a broader scope, including compliance and auditing standards, whereas examiners handle day-to-day claim processing.

How do you become a health insurance auditor?

To become a health insurance auditor, candidates typically need a bachelor's degree in accounting, finance, or a related field. Relevant experience in insurance, healthcare, or auditing, along with knowledge of healthcare regulations and auditing standards, is important. Professional certifications such as Certified Internal Auditor (CIA) or Certified Public Accountant (CPA) can enhance job prospects.

What do you need to be a health insurance auditor?

To become a health insurance auditor, candidates typically need a bachelor's degree in accounting, finance, or a related field, along with experience in healthcare or insurance. Strong analytical skills, attention to detail, and knowledge of insurance regulations and billing practices are essential. Certifications such as Certified Healthcare Auditor (CHA) can enhance job prospects.

What does a health insurance auditor do in healthcare?

A health insurance auditor reviews healthcare claims, billing records, and policy compliance to ensure accuracy and prevent fraud. They analyze data using auditing tools and often require knowledge of healthcare regulations and insurance policies to verify that services billed match provided care and adhere to coverage guidelines.

What are popular job titles related to Health Insurance Auditor jobs in Tennessee?

For Health Insurance Auditor jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Health Insurance Auditor jobs in Tennessee look for?

The top searched job categories for Health Insurance Auditor jobs in Tennessee are:

What cities in Tennessee are hiring for Health Insurance Auditor jobs?

Cities in Tennessee with the most Health Insurance Auditor job openings:

Health Insurance Auditor jobs near you
Infographic showing various Health Insurance Auditor job openings in Tennessee as of August 2026, with employment types broken down into 60% Full Time, and 40% Part Time. Highlights an 100% In-person job distribution, with an average salary of $49,532 per year, or $23.8 per hour.

Claims Auditor

American Health Partners

Franklin, TN • Hybrid

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 27 days ago

Key responsibilities

  • Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials

  • Work closely with delegated claim processor to review and correct errors prior to final payment

  • Participate in and support ad-hoc audits as needed

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com. 

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! 

Benefits and Perks include:

  • Affordable Medical/Dental/Vision insurance options
  • Generous paid time-off program and paid holidays for full time staff
  • TeleMedicine 24/7/365 access to doctors
  • Optional short- and long-term disability plans
  • Employee Assistance Plan (EAP)
  • 401K retirement accounts
  • Employee Referral Bonus Program

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. 

  • Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
  • Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
  • Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
  • Work assigned claim projects to completion
  • Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
  • Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
  • Maintain production and quality standards as established by management
  • Participate in and support ad-hoc audits as needed
  • Other duties as assigned

JOB REQUIREMENTS:

  • Proficient in processing/auditing claims for Medicare and Medicaid plans
  • Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
  • Current experience with both Institutional and Professional claim payments
  • Knowledge of automated claims processing systems
  • Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.

REQUIRED QUALIFICATIONS:

  • Experience:
    • Two (2) years’ experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
    • Two (2) years’ experience in managed healthcare environment related to claims processing/audit
    • Two (2) years’ experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
    • Two (2) years’ experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
    • Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans
  • License/Certification(s):
    • Coding certification preferred

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

 This employer participates in E-Verify.

American Health Partners logo

About American Health Partners

Sourced by ZipRecruiter

American Health Partners is a family of six divisions staffed by outstanding employees who care deeply about others. Since our inception more than 45 years ago, we have been committed to bringing the highest quality healthcare available to our communities. That commitment continues to serve us, our patients, our customers and our partners well. Today, our diverse healthcare offerings serve nearly 12,000 individuals annually across multiple states. We operate in both urban and rural communities where people need healthcare close to home. By working closely with hospitals and other providers, we offer cost-effective options that give individuals greater control over their healthcare.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Franklin, TN, US

Year founded

1976

Social media

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