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Insurance Claims Auditor Jobs (NOW HIRING)

Regal Medical Group, Inc.

$22.50 - $24.50/hr

... Plan information to which Claims Auditing Specialist has access. Essential Duties and ... Vision insurance * Zero co-payments for employed physician office visits * Flexible Spending ...

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · On-site +1

Claims Quality Auditor| Remote Job Type: Full time Work Setup: Remote Reports to: Claims Supervisor ... Familiarity with Medi-Cal and Commercial insurance claim * Strong analytical and problem-solving ...

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · Remote

Claims Quality Auditor| Remote Job Type: Full time Work Setup: Remote Reports to: Claims Supervisor ... Familiarity with Medi-Cal and Commercial insurance claim * Strong analytical and problem-solving ...

ImageNetLLC

Claims Quality Auditor - Remote

Tampa, FL · Remote

Salary: Claims Quality Auditor| Remote Job Type: Full time Work Setup: Remote Reports to: Claims ... Familiarity with Medi-Cal and Commercial insurance claim * Strong analytical and problem-solving ...

Valenz

Certified Medical Claims Auditor

Phoenix, AZ · Remote

As a Certified Medical Claims Auditor (Clinical Bill Review Analyst), you'll review claims upfront ... Knowledge of Health Insurance, Medicare guidelines and various healthcare programs. * RevCycle Pro ...

Tokio Marine HCC

Specific Claims Auditor

$40K - $80K/yr

Help us insure it Tokio Marine HCC is a global industry-leading specialty insurance group, backed ... Under supervision, investigates claims liability and determine the extent of liability on a ...

Ourhrconnect

$74K - $97K/yr

Effectively mitigate client medical stop loss claims and provide excellent customer service ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

Ourhrconnect

$74K - $97K/yr

Effectively mitigate client medical stop loss claims and provide excellent customer service ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

Ourhrconnect

$74K - $97K/yr

Effectively mitigate client medical stop loss claims and provide excellent customer service ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

Ourhrconnect

Auditor, Sr Stoploss Claim

Alexandria, VA · On-site +1

$74K - $97K/yr

Effectively mitigate client medical stop loss claims and provide excellent customer service ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

Ourhrconnect

Auditor, Sr Stoploss Claim

Kansas, OK · On-site +1

$74K - $97K/yr

Effectively mitigate client medical stop loss claims and provide excellent customer service ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

Ourhrconnect

Auditor, Sr Stoploss Claim

Tennessee, IL · On-site +1

$74K - $97K/yr

Effectively mitigate client medical stop loss claims and provide excellent customer service ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

Ourhrconnect

Auditor, Sr Stoploss Claim

Miami Beach, FL · On-site +1

$74K - $97K/yr

Effectively mitigate client medical stop loss claims and provide excellent customer service ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

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Insurance Claims Auditor information

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How much do insurance claims auditor jobs pay per hour?

As of Jun 18, 2026, the average hourly pay for insurance claims 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 are the key skills and qualifications needed to thrive as an Insurance Claims Auditor, and why are they important?

To thrive as an Insurance Claims Auditor, you need a strong background in insurance policies, claims processes, and auditing principles, often supported by a degree in finance, accounting, or a related field. Familiarity with claims management software, auditing tools, and industry certifications like CPCU or AIC is commonly required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for evaluating claims accuracy and collaborating with stakeholders. These skills ensure accurate claims processing, regulatory compliance, and help reduce financial risk for the organization.

What does an Insurance Claims Auditor do?

An Insurance Claims Auditor reviews and evaluates insurance claims to ensure they are processed accurately and comply with company policies and industry regulations. They verify the validity of claims, check for errors or fraudulent activity, and assess whether the correct procedures were followed. By analyzing documentation and audit trails, they help insurance companies minimize risk and improve operational efficiency. Their work supports fair claim settlements and helps maintain trust between insurers and policyholders.

What is the difference between Insurance Claims Auditor vs Insurance Claims Processor?

AspectInsurance Claims AuditorInsurance Claims Processor
Primary RoleReview and verify insurance claims for accuracy and complianceInput and process insurance claims for payment
Required SkillsAttention to detail, knowledge of insurance policies, auditing skillsData entry, customer service, basic insurance knowledge
Work EnvironmentOffice setting, often in insurance or healthcare companiesOffice or remote, handling claims processing tasks
CertificationsMay require insurance or auditing certificationsLess likely to require specialized certifications

Insurance Claims Auditors focus on reviewing and verifying claims for accuracy, ensuring compliance with policies, while Insurance Claims Processors handle the initial data entry and processing of claims. Both roles are essential in the insurance industry but differ in responsibilities and skill requirements.

What are some of the key challenges an Insurance Claims Auditor may face in their daily work?

Insurance Claims Auditors often encounter challenges such as identifying subtle discrepancies in large volumes of claims, ensuring compliance with complex regulatory standards, and keeping up with frequent changes in industry practices. They must balance efficiency with accuracy while reviewing claim files, and may need to communicate findings diplomatically with claims adjusters and management. Additionally, auditors may face tight deadlines, making strong organizational and time management skills essential for success in this role.
More about Insurance Claims Auditor jobs
What states have the most Insurance Claims Auditor jobs? States with the most job openings for Insurance Claims Auditor jobs include:
Insurance Claims Auditor jobs near you
Infographic showing various Insurance Claims Auditor job openings in the United States as of June 2026, with employment types broken down into 1% As Needed, 74% Full Time, 19% Part Time, and 6% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $55,805 per year, or $26.8 per hour.
Claims Auditor, Managed Care (remote)

Claims Auditor, Managed Care (remote)

Cedars Sinai

Los Angeles, CA • On-site

Other

Medical, Dental

Posted 20 days ago

Cedars-Sinai rating

8.6

Company rating: 8.6 out of 10

Based on 129 frontline employees who took The Breakroom Quiz

36th of 1,000 rated hospitals

Job description

Are you ready to bring your clinical competencies to a world-class Medical Group known for the very highest clinical standards? Do you have a passion for the highest quality and patient satisfaction? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.

The Cedars-Sinai Medical Network is committed to helping primary care and specialist physicians provide excellent care to all their patients, who benefit from convenient access to primary and specialty care physicians and seamless coordination of care between them. As a part of Cedars-Sinai, our physicians and staff are partners in quality health care from a medical center that is consistently recognized as one of the finest hospitals in the country. For the 8th consecutive year, we have been named one of the top 20 Physician Groups in Southern California by Integrated Healthcare Associates (IHA).

Why work here?

Beyond outstanding benefits, competitive salaries and health and dental insurance we take pride in hiring the best, most passionate employees. Our talented staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.

What will you be doing in this role?

The Claims Auditor is responsible for ensuring the accuracy of claims processing based on department policies and procedures, CMS and DMHC regulations.

Primary Duties and Responsibilities
  • Conducts detailed audits for compliance with State, Federal and Health Plan regulatory requirements
  • Conducts pre and post payment audits on adjudicated claims in compliance with Cedar-Sinai policies, procedures and payment methodologies
  • Documents audit findings and presents errors to Claims Operations for corrections, root cause analysis and appropriate resolution
  • Provides analysis and prepares recommendations to Management for errors and inconsistences
  • Provides process improvement suggestions to Management Monitors appeals from providers, members and health plans to make sure they are processed accurately and in timely manner.
  • Monitors the daily auditing of processed claims and letters for accuracy.
  • Distributes and monitors multiple projects to make sure deadlines are met.
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai's medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.Job qualificationsEducation
  • High School Diploma/GED required
  • Bachelor's Degree healthcare or related field preferred
Work Experience
  • 4 years of professional and facility claims processing for Medicare and Commercial products. Must be familiar with provider dispute resolution preferred
  • 5 years of Senior/Lead or Claim Audit experience in a medical claim setting preferred

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