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Medical Claims Auditor Jobs (NOW HIRING)

University Health

Claims Auditor

San Antonio, TX

$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

UHS

Claims Auditor/Trainer

Reno, NV

Excellent Medical, Dental, Vision and Prescription Drug Plans * 401(K) with company match and ... are claims processing, auditing, or training. · High school diploma or equivalent required;

UHS

Claims Auditor/Trainer

Reno, NV · On-site

$26.65 - $38/hr

Excellent Medical, Dental, Vision and Prescription Drug Plans * 401(K) with company match and ... are claims processing, auditing, or training. • High school diploma or equivalent required;

Cardinal Health

$33/hr

Summary The Durable Medical Equipment Supplies Claims Auditor plays a key role in supporting Cardinal Health's Ethics and Compliance program by helping ensure claims-related processes are accurate ...

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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 10, 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.

Claims Auditor

University Health - San Antonio

San Antonio, TX • On-site

Full-time

Re-posted 26 days ago

Job description

POSITION SUMMARY/RESPONSIBILITIES
Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representative training needs that can be used to improve performance. Requires knowledge of claims processing for HCFA and UB92 for both commercial and Medicaid programs and knowledge of CFHP claims payment processing system, Amisys.

EDUCATION/EXPERIENCE
High school diploma or equivalency is required. Minimum of five years experience in insurance, medical or managed care environment including two years of claim processing experience required. Previous auditing and/or Amisys experience preferred.

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