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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

SW Engineer (DevOps)

Prosper, TX · Remote

$54 - $74/hr

... legacy claim auditing system. You'll analyze the needs and the environment to make sure the ... the medical claim, member and provider data. • Should have worked on agile based projects. • ...

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How much do medical claim auditor jobs pay per hour?

As of Jul 19, 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 do I become a medical auditor?

To become a medical claim auditor, typically one needs a background in healthcare, such as a nursing or medical billing certification, along with knowledge of medical coding and billing procedures. Many employers prefer candidates with experience in medical records review or insurance claims processing, and obtaining certifications like the Certified Professional Medical Auditor (CPMA) can enhance job prospects.

How to become a medical claims auditor?

To become a medical claims auditor, individuals typically need a high school diploma or equivalent, with many employers preferring postsecondary education or certification in health information management or medical billing. Relevant skills include attention to detail, knowledge of medical coding and billing, and familiarity with insurance policies and regulations. Certification programs such as the Certified Professional Coder (CPC) or Certified Medical Auditor (CMA) can enhance job prospects.

What are the key skills and qualifications needed to thrive in the Medical Claim Auditor position, and why are they important?

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.

Is an auditor a high paying job?

Medical claim auditors typically earn a moderate to high salary depending on experience, certifications, and location. Senior auditors or those with specialized skills can earn higher wages, and the role often offers opportunities for advancement and additional benefits.

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.

What is a medical claims audit?

A medical claims audit is a review process performed by a Medical Claim Auditor to verify the accuracy, completeness, and compliance of healthcare claims submitted by providers. It involves examining medical records, billing codes, and documentation to detect errors, fraud, or overpayments, often using specialized software and industry standards. This process helps ensure proper reimbursement and adherence to healthcare regulations.
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Medical Claim Auditor jobs near you
Infographic showing various Medical Claim Auditor job openings in the United States as of July 2026, with employment types broken down into 83% Full Time, 14% Part Time, 2% Contract, and 1% Nights. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $53,259 per year, or $25.6 per hour.
Claim Auditor Payment Integrity (44544)

Claim Auditor Payment Integrity (44544)

Neighborhood Health Plan of Rhode Island

Smithfield, RI • Remote

Full-time

Posted yesterday

Job description

The Claim Auditor in Payment Integrity will address problematic and complex audit assignments to identify claim overpayments in accordance with established billing and coding parameters. Claim payment accuracy will be recognized through sound audit review methods and practices, including but not limited to; claim payment evaluation, medical chart review, claim payment data analysis and assessment of established organizational contractual parameters. Independently analyzes, extracts, refines, and interprets claims data for actionable insights. The Auditor uses self-directed, decision making and problem solving that directly impacts financial outcomes and results.

Duties and Responsibilities:

Responsibilities include, but are not limited to:

  • Investigate potential over-utilization by performing audits thought pre and post claim payment.
  • Initiate and verify claims adjustments, maintain audit documentation, and prepare savings reports.
  • Identify new audit areas through data mining and performing sample audits.
  • Develops reports and deliverables for management and communicates with all levels of stakeholders.
  • Provide recommendations and collaborate with Payment Integrity team on audit outcomes, identified issues, recommended modifications to clinical medical policies, billing and reimbursement guidelines, and online provider manual.
  • Serve as contact with all operational areas relevant to Payment Integrity audit decisions.
  • Represent company in internal and external meetings/conference calls when needed to discuss audit results or perform coding education.
  • Performs other duties as assigned

Qualifications

Required:

  • Associate’s degree or equivalent of three (3) years of claim review work experience to equate to the degree
  • Experience in medical records review, claims processing or utilization/case management in clinical practice or managed care organization
  • Fundamental knowledge of Medicare/Medicaid Guidelines
  • Experience with provider payment methodologies
  • Critical thinking and judgment/decision making skills
  • Solutions oriented-positive attitude
  • Independent problem solving-innovative thinker
  • Strong communication skills (written/verbal)
  • Excellent Customer Service skills
  • Ability to effectively prioritize and execute tasks in a high-pressure environment
  • Intermediate to Advanced skills in Microsoft Office (Word, Excel, Outlook)
  • Ability to work independently as well as part of a team

Preferred:

  • American Academy of Professional Coder’s (AAPC) COC and/or CIC
  • Data analytics experience
  • Knowledge of COGNOS reporting environment

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.  

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