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Medical Claim Auditor Jobs (NOW HIRING)

Codoxo

Data Mining Auditor- Payment Integrity

The Data Mining Auditor performs medical claim audits to identify overpaid claims, through review of billing and coding policies, provider contract language, and State and Federal regulations. Audits ...

Vytwo Technologies Inc.

SW Engineer (DevOps)

$54 - $74/hr

... auditing system. The role involves analyzing needs and ensuring solutions align with current ... Responsibilities : • Good knowledge of the medical claim, member and provider data. • Should ...

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. • ...

Vytwo

SW Engineer (DevOps)

Prosper, TX · Remote

$54 - $74/hr

... auditing system. You'll analyze the needs and the environment to make sure the solution you're ... Good knowledge of the medical claim, member and provider data. * Should have worked on agile based ...

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How much do medical claim auditor jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for 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.

How to become a medical claim auditor?

To become a medical claim auditor, typically a high school diploma or equivalent is required, with many employers preferring candidates with a bachelor's degree in health administration, accounting, or a related field. Relevant experience in healthcare billing, coding, or insurance claims is often necessary, along with knowledge of medical terminology and coding systems like ICD or CPT. Certification such as the Certified Professional Coder (CPC) or Certified Medical Auditor (CMA) can enhance job prospects and credibility in the field.

What are the key skills and qualifications needed to thrive as a medical claim auditor?

A Medical Claim Auditor needs strong analytical skills, attention to detail, and a solid understanding of healthcare billing, coding systems, and insurance regulations, often supported by a background in health information management or a related field. Familiarity with auditing software, claim management systems, and certifications such as Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS) is highly regarded. Excellent organizational skills, effective communication, and the ability to work independently or within a team set top performers apart. These skills ensure accurate claim reviews, compliance with guidelines, and help minimize financial risk for healthcare providers and insurers.

What does a medical claim auditor do?

A Medical Claim Auditor reviews healthcare claims to ensure accuracy, compliance with regulations, and proper billing practices. They verify coding, detect errors or fraud, and confirm that services are billed according to insurance policies. Their role helps prevent overpayments, reduces financial risks, and ensures that providers and insurers follow industry standards. Strong analytical skills and knowledge of medical coding (such as ICD-10 and CPT) are essential in this position.

How do I become a medical claim auditor?

To become a medical claim auditor, typically a high school diploma or equivalent is required, with many employers preferring candidates with a bachelor's degree in health administration, accounting, or a related field. Relevant skills include attention to detail, knowledge of medical billing and coding, and familiarity with healthcare regulations; certifications such as the Certified Professional Medical Auditor (CPMA) can enhance job prospects. Gaining experience through entry-level positions in healthcare or insurance companies is also beneficial.

What are some of the main challenges medical claim auditors face in their daily work?

Medical Claim Auditors often face the challenge of reviewing high volumes of complex claims while ensuring accuracy and compliance with ever-changing healthcare regulations. Attention to detail is critical, as errors can lead to rejected claims or financial losses for both providers and insurers. They must stay updated on coding changes and payer requirements, which requires ongoing learning and adaptability. Collaborating with billing departments, healthcare providers, and payers to resolve discrepancies or clarify documentation is also a key part of their role.

Is medical claim auditing a good career?

Medical claim auditing is a stable career that involves reviewing insurance claims for accuracy and compliance, often requiring attention to detail and knowledge of healthcare regulations. It can offer opportunities for remote work, certification, and career advancement within the healthcare and insurance industries.
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Medical Claim Auditor jobs near you
Infographic showing various Medical Claim Auditor job openings in the United States as of August 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 100% In-person job distribution, with an average salary of $53,259 per year, or $25.6 per hour.

Claim Auditor I

Cook Children's Health Care System

Fort Worth, TX

Full-time

Re-posted 19 days ago

Cook Children's Health Care System rating

7.9

Company rating: 7.9 out of 10

Based on 77 frontline employees who took The Breakroom Quiz

108th of 887 rated healthcare providers

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.

What Cook Children's Health Care System employees say

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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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