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Managed Care Auditor Jobs (NOW HIRING)

Independent Living Systems

Claims Auditor

Miami, FL · On-site

By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors. Ultimately, this role supports the delivery ...

Independent Living Systems

Claims Auditor

Miami, FL · On-site

By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors. Ultimately, this role supports the delivery ...

WakeMed

Director, Managed Care Contracting

Raleigh, NC · On-site

When requested, interfaces with external and third party auditors; prepares and defends contract ... Or Healthcare Management Or Accounting Required - With College Courses Finance Required - And ...

Molina Healthcare

Auditor, Healthcare Services

Waltham, MA · On-site

$30.37 - $59.21/hr

Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...

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WellSpace Health

Be Seen First

Performance and Compliance Auditor

Sacramento, CA · On-site

$95K - $108K/yr

Performance and Compliance Auditor Department/Care Stream: Compliance LIA Reporting Structure Timecard Approver: Compliance and Operational Risk Manager Primary: Compliance and Operational Risk ...

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Managed Care Auditor information

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$10

$19

$46

How much do managed care auditor jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for managed care auditor in the United States is $19.21, according to ZipRecruiter salary data. Most workers in this role earn between $14.42 and $19.23 per hour, depending on experience, location, and employer.

What is a managed care auditor?

A Managed Care Auditor is a professional who reviews and evaluates healthcare claims, billing records, and contracts to ensure compliance with managed care agreements and regulatory requirements. They work for insurance companies, healthcare providers, or third-party organizations to identify errors, prevent fraud, and ensure that reimbursements are accurate. Managed Care Auditors help organizations optimize their processes, reduce costs, and maintain compliance with healthcare laws and policies. Their work plays a crucial role in safeguarding the financial integrity of managed care programs.

What are the key skills and qualifications needed to thrive as a managed care auditor?

To thrive as a Managed Care Auditor, you need in-depth knowledge of healthcare compliance, claims auditing, and managed care regulations, often supported by a degree in healthcare administration or a related field. Familiarity with claims processing systems, medical coding software (such as ICD-10 and CPT), and audit management tools is typically required, with certifications like Certified Professional Medical Auditor (CPMA) being advantageous. Attention to detail, analytical thinking, and strong communication skills help auditors identify discrepancies and collaborate with stakeholders. These skills are crucial for ensuring healthcare providers and payers adhere to regulatory standards and optimize financial performance.

What are some common challenges faced by managed care auditors when working with healthcare providers and payers?

Managed Care Auditors often encounter challenges such as navigating complex contract terms, interpreting varying payer requirements, and keeping up with frequent regulatory changes. Coordinating with healthcare providers and insurance companies can also be demanding, as it requires strong communication and negotiation skills to resolve discrepancies. Additionally, Managed Care Auditors must maintain accuracy and attention to detail while analyzing large volumes of medical and financial data, all within tight deadlines.

What is the difference between Managed Care Auditor vs Claims Reviewer?

AspectManaged Care AuditorClaims Reviewer
Required CredentialsCertifications like CHC, CPC, or relevant healthcare auditing credentialsOften CPC, CCS, or claims processing certifications
Work EnvironmentHealthcare organizations, insurance companies, government agenciesInsurance companies, healthcare providers, third-party administrators
Employer & Industry UsageUsed in managed care plans, health insurance, and healthcare complianceCommon in insurance claims processing and reimbursement review

While both roles involve reviewing healthcare-related documents, Managed Care Auditors focus on evaluating the accuracy and compliance of managed care plans, whereas Claims Reviewers primarily assess individual insurance claims for correctness and eligibility. The roles often overlap in credentials and work environments but differ in scope and focus within the healthcare reimbursement process.

More about Managed Care Auditor jobs

What cities are hiring for Managed Care Auditor jobs?

Cities with the most Managed Care Auditor job openings:

What states have the most Managed Care Auditor jobs?

States with the most job openings for Managed Care Auditor jobs include:

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The top searched job categories for Managed Care Auditor jobs are:

Managed Care Auditor jobs near you
Infographic showing various Managed Care Auditor job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 71% Full Time, 20% Part Time, and 7% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $39,947 per year, or $19.2 per hour.

Compliance Auditor II

Inland Empire Health Plans

Rancho Cucamonga, CA • On-site

$90 - $120/hr

Other

Medical, Dental, Vision, Life, Retirement

Posted 10 days ago

Job description

Overview

What you can expect: Find joy in serving others with IEHP. We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience.

The Compliance Auditor II conducts comprehensive audits and reviews across the Plan, including assigned areas and Plan delegates, to ensure adherence to Federal, State, and contractual regulatory requirements. Identifies and assesses risks impacting overall compliance, drafts detailed audit findings and actionable recommendations, and evaluates operations, policies, and processes throughout the Plan. Conducts evaluations of operations, policies, and processes to validate compliance, evaluate effectiveness, and identify issues. Issues corrective action plans and reviews for acceptance to ensure that all compliance issues are appropriately addressed. Performs validation audits to determine if actions have been taken to mitigate identified risks and conducts routine monitoring across the Plan to address compliance concerns and emerging risks. Participates in special reviews as necessary.

Commitment to Quality: The IEHP Team is committed to incorporating IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

  • Competitive salary
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Life, short-term, and long-term disability options
  • Career advancement opportunities and professional development
  • Wellness programs that promote a healthy work-life balance
  • Flexible Spending Account – Health Care/Childcare
  • CalPERS retirement
  • 457(b) option with a contribution match
  • Paid life insurance for employees
  • Pet care insurance
Education & Requirements
  • Minimum five (5) years in managed care operations, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, Delegation Oversight, Quality Management, Care Management, and/or Grievances and Appeals
  • Demonstrated experience, at a professional level, in an audit role
  • Experience with interpretation and/or implementation of California managed care regulations
  • Two (2) years of audit or quality assurance/quality improvement experience required
  • Bachelor’s degree from an accredited institution required
  • In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position; this experience is in addition to the minimum years listed in the Experience Requirements above
  • Certified Internal Auditor (CIA), Certified Health Care Compliance (CHC), Certified Healthcare Auditor (CHA), and/or CHIAP (Certified Healthcare Internal Audit Professional) preferred
Key Qualifications
  • Demonstrated understanding of audit standards and requirements, statistical data interpretation and applicability, risk assessment and control environments, audit theory and processes, and the professional practice standards of internal auditing
  • Demonstrated current knowledge of business ethics and compliance risks and the knowledge to assist with management of those risks in a dynamic health care environment
  • Proficient knowledge of CMS Program Audit Protocols, DHCS Technical Assistance Guides, and DMHC Technical Assistance Guides
  • Knowledge of regulatory research and regulations that apply to California Managed Care Health Plans
  • Possess strong written and verbal communication skills, including a strong business writing aptitude
  • Possess strong problem solving and creative thinking skills and the ability to reprioritize workload as needed
  • Must be detail oriented, self-directed, and work with minimal supervision, both independently and in teams
  • Requires well-developed skills in problem identification, analysis, resolution, organization, prioritization, timeliness, and attention to detail
  • Proficient in Microsoft applications (Word, Excel, PowerPoint, Outlook, etc.). Advanced skills in MS Excel preferred
  • Effective in a consulting role with the ability to become a trusted advisor
  • Ability to maintain excellent interpersonal relationships within the department and at all levels of the organization
  • Ability to organize thoughts and data into well-organized communications and reports

Start your journey towards a thriving future with IEHP and apply today!

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