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Medical Claims Auditor Jobs (NOW HIRING)

Moda Health

Lead Medical Claims Auditor I

Milwaukie, OR · On-site

$20.88 - $23.49/hr

Medical, Dental, Vision, Pharmacy, Life, & Disability * 401K- Matching * FSA * Employee Assistance ... Minimum of 2 years of experience as a Claims Auditor. * Excellent reading, verbal and written ...

RiteChoice Rx

Claims Auditor

Pharmacy auditing, medical billing auditing, or pharmacy technician experience is strongly preferred. Supervision The Claims Auditor will report directly to the Compliance Manager. * This is a ...

University Health

Claims Auditor

San Antonio, TX · On-site

$19.55 - $29.75/hr

POSITION SUMMARY/RESPONSIBILITIES Responsible for development and maintenance of claims auditing ... Minimum of five years experience in insurance, medical or managed care environment including two ...

University Health

Claims Auditor

San Antonio, TX · On-site

$19.55 - $29.75/hr

POSITION SUMMARY/RESPONSIBILITIES Responsible for development and maintenance of claims auditing ... Minimum of five years experience in insurance, medical or managed care environment including two ...

University Health

Claims Auditor

San Antonio, TX · On-site

$19.55 - $29.75/hr

POSITION SUMMARY/RESPONSIBILITIES Responsible for development and maintenance of claims auditing ... Minimum of five years experience in insurance, medical or managed care environment including two ...

Health Source MSO

Claims Auditor

Alhambra, CA · On-site

Claims Auditor will be responsible for auditing claims processed by Claims Examiners ... Medical Insurance Dental Insurance Vision Insurance Life Insurance 401K Matching Paid Time Off

American Health Partners

Claims Auditor

Franklin, TN · Hybrid

Affordable Medical/Dental/Vision insurance options * Generous paid time-off program and paid ... Proficient in processing/auditing claims for Medicare and Medicaid plans * Strong knowledge of CMS ...

American Health Partners

Claims Auditor

Franklin, TN · On-site

Affordable Medical/Dental/Vision insurance options * Generous paid time-off program and paid ... Proficient in processing/auditing claims for Medicare and Medicaid plans * Strong knowledge of CMS ...

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Medical Claims Auditor information

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How much do medical claims auditor jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for medical claims 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.

What is the difference between Medical Claims Auditor vs Medical Billing Specialist?

AspectMedical Claims AuditorMedical Billing Specialist
CredentialsCertification (e.g., CPC, CCA), relevant experienceCertification (e.g., CPC), relevant experience
Work EnvironmentInsurance companies, healthcare facilities, auditing firmsMedical offices, billing companies, healthcare providers
Job FocusReviewing and verifying insurance claims for accuracy and compliancePreparing and submitting insurance claims, patient billing

Medical Claims Auditors focus on reviewing and verifying insurance claims for accuracy, ensuring compliance with policies. Medical Billing Specialists handle the preparation and submission of claims and patient billing. While both roles require similar certifications and work in healthcare settings, their primary responsibilities differ: auditing versus billing.

What does a medical claims auditor do?

A Medical Claims Auditor is responsible for reviewing and evaluating healthcare claims to ensure accuracy, compliance with regulations, and proper billing practices. They analyze medical records, billing codes, and insurance policies to detect errors, fraud, or overpayments. Their work helps healthcare providers and insurance companies maintain financial integrity and meet legal standards. Medical Claims Auditors often collaborate with medical staff, coders, and insurance representatives to resolve discrepancies and improve processes.

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

To thrive as a Medical Claims Auditor, you need a solid understanding of medical billing, coding standards (such as ICD-10 and CPT), and healthcare regulations, often supported by a degree in health information management or a related field. Familiarity with claims processing software, electronic health records (EHRs), and relevant certifications like Certified Professional Medical Auditor (CPMA) are typically required. Attention to detail, analytical thinking, and strong communication skills help auditors identify discrepancies and collaborate effectively with providers and insurers. These competencies are crucial to ensure accurate claims processing, reduce fraud, and maintain compliance with healthcare regulations.

What are some common challenges faced by medical claims auditors and how are they typically addressed?

Medical Claims Auditors often encounter challenges such as interpreting complex medical records, staying updated with ever-changing healthcare regulations, and identifying errors or fraud within large volumes of claims data. To address these challenges, auditors rely on continual professional development, robust auditing software, and close collaboration with billing departments and medical staff. Working as part of a team, they frequently hold review meetings to discuss ambiguous cases and share insights on best practices, ensuring accuracy and compliance across all audits.
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Medical Claims Auditor jobs near you
Infographic showing various Medical Claims 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.

Medical Claims Auditor (Hybrid)

Northwest Administrators, Inc.

Seattle, WA • Hybrid

$30.70 - $41.54/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago

Job description

Are you a skilled communicator with strong writing abilities and deep claims experience? Do you have actual hands-on experience processing medical claims, from beginning to end? Do you enjoy applying your medical claims expertise to work one-on-one, or in small group settings, to help others strengthen their accuracy, compliance, and performance? If you answered 'YES' to these questions, then you may be the person we're seeking for our Claims Auditor position!

What you'll be doing...

As a Health and Welfare Claims Auditor, the main focus will be to review the work completed by the Health and Welfare Medical, Dental, Vision, Time Loss and Life Claims Processors. This position requires collaboration with other auditors, outside vendors, account executives, department supervisors and managers, and medical consultants.

Primary responsibilities for this position include:

  • Perform internal audits of our Health and Welfare Claims Processors' work
  • Design and implement training plans for Claims Processors
  • Conduct training sessions for groups of new Claims Processors
  • Train and cross-train on plan, system and procedural changes
  • Respond to day-to-day referral questions
  • Perform random and large dollar claims audits
  • Prepare written claim processing guideline materials
  • Coordinate vendor interaction with specific PPOs and benefit providers

This position has a hybrid work schedule with 3 days per week in office, after the completion of training. The position can be based in the Seattle, Mountlake Terrace or Federal Way office.

Who you are...

  • Educated. Bachelor's degree preferred or equivalent combination of education & experience
  • Experienced. Medical & Dental Claims processing; auditing/training experience preferred
  • Organized. Able to prioritize work, multi-task and work independently
  • Communicator. Excellent verbal, written and interpersonal communication skills
  • Technically Savvy. Intermediate level experience using Microsoft Office Suite of tools

Who we are...

Northwest Administrators, Inc. is an industry leader in third-party administration of employee benefits. We administer one of the largest multi-employer pension plans in the country, along with numerous large health and welfare plans. As part of our team, you will benefit from many training and development opportunities and can expect a better-than-market benefits package. See what our associates are saying about us at Northwest Administrators Inc. | Careers (nwadmin.com)

If hired, you can expect...

  • Hourly rate range of $30.70 - $41.54 per hour (dependent upon experience & qualifications)
  • Medical, dental (w/Orthodontia), vision, Rx benefits, disability & life insurance
  • Optional benefits: health flex spending, dependent care assistance & pet insurance
  • Generous 401(k) plan with employer base contribution and match
  • Paid Vacation (10 days), Sick Leave (10 days) and Holidays (10 days)
  • Collaborative team environment
  • Work-life balance

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