Claims Auditor Lead
Wilmington, DE · Hybrid
Claims Auditor Lead Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 ... Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy.
Claims Auditor Lead
Wilmington, DE · Hybrid
Claims Auditor Lead Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 ... Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy.
Claims Auditor Lead
Atlanta, GA · On-site
Claims Auditor Lead Claims Auditor Lead Hybrid 1: This role requires associates to be in-office 1 - ... Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy.
Claims Auditor Lead
Atlanta, GA · On-site
Claims Auditor Lead Claims Auditor Lead Hybrid 1: This role requires associates to be in-office 1 - ... Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy.
Claims Auditor Lead
Nashville, TN · Hybrid
Claims Auditor Lead Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 ... Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy.
Claims Auditor Lead
Nashville, TN · Hybrid
Claims Auditor Lead Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 ... Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy.
Claims Auditor/Trainer
Reno, NV · On-site
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;
Claims Auditor/Trainer
Reno, NV · On-site
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;
$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 ...
$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 ...
$72K - $94K/yr
Effectively mitigate client medical stop loss claims and provide excellent customer service ... Develop new and review old stop loss claim forms. Assist with internal auditing of claims auditors ...
$72K - $94K/yr
Effectively mitigate client medical stop loss claims and provide excellent customer service ... Develop new and review old stop loss claim forms. Assist with internal auditing of claims auditors ...
The Contractor shall provide expertise in quality assurance, claims processing, medical coding, and ... auditing. * Demonstrated expertise is in CPT, HCPC and ICD billing codes, authorization ...
The Contractor shall provide expertise in quality assurance, claims processing, medical coding, and ... auditing. * Demonstrated expertise is in CPT, HCPC and ICD billing codes, authorization ...
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;
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;
The Contractor shall provide expertise in quality assurance, claims processing, medical coding, and ... auditing. * Demonstrated expertise is in CPT, HCPC and ICD billing codes, authorization ...
The Contractor shall provide expertise in quality assurance, claims processing, medical coding, and ... auditing. * Demonstrated expertise is in CPT, HCPC and ICD billing codes, authorization ...
The Contractor shall provide expertise in quality assurance, claims processing, medical coding, and ... auditing. * Demonstrated expertise is in CPT, HCPC and ICD billing codes, authorization ...
The Contractor shall provide expertise in quality assurance, claims processing, medical coding, and ... auditing. * Demonstrated expertise is in CPT, HCPC and ICD billing codes, authorization ...
Medical Records Claims Auditor
Cerritos, CA · On-site
$24 - $28/hr
... auditing, and monitoring processes as they relate to billing to assure accurate claims and ... Strong understanding of insurance terms, medical terminology, pricing methodologies for commercial ...
Quick apply
Medical Records Claims Auditor
Cerritos, CA · On-site
$24 - $28/hr
... auditing, and monitoring processes as they relate to billing to assure accurate claims and ... Strong understanding of insurance terms, medical terminology, pricing methodologies for commercial ...
Claim Auditor I
Fort Worth, TX · On-site
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 ...
Claim Auditor I
Fort Worth, TX · On-site
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 ...
Claim Auditor I
Fort Worth, TX · On-site
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 ...
Claim Auditor I
Fort Worth, TX · On-site
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 ...
Auditor, Insurance Claims
Irving, TX · On-site
$22/hr
The primary purpose and function of the Auditor, Insurance Claims is to adjudicate, re-bill and ... Benefits * Medical, dental, and vision insurance * Paid time off * Tuition Reimbursement * 401K
Auditor, Insurance Claims
Irving, TX · On-site
$22/hr
The primary purpose and function of the Auditor, Insurance Claims is to adjudicate, re-bill and ... Benefits * Medical, dental, and vision insurance * Paid time off * Tuition Reimbursement * 401K
Specific Stop Loss Claims Auditor
$51K - $75K/yr
The Health Claims Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files ... first dollar medical). * Strong understanding of claims handling and insurance regulations.
Specific Stop Loss Claims Auditor
$51K - $75K/yr
The Health Claims Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files ... first dollar medical). * Strong understanding of claims handling and insurance regulations.
Specific Stop Loss Claims Auditor
$51K - $75K/yr
The Health Claims Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files ... first dollar medical). * Strong understanding of claims handling and insurance regulations.
Specific Stop Loss Claims Auditor
$51K - $75K/yr
The Health Claims Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files ... first dollar medical). * Strong understanding of claims handling and insurance regulations.
Claims Quality Assurance Auditor
Whittier, CA · On-site
$23 - $36.70/hr
... medical (physician) group, home healthcare services and hospice care, as well as heart, cancer ... Claims auditing and understanding claims processing in a claims department * Experience with ...
Claims Quality Assurance Auditor
Whittier, CA · On-site
$23 - $36.70/hr
... medical (physician) group, home healthcare services and hospice care, as well as heart, cancer ... Claims auditing and understanding claims processing in a claims department * Experience with ...
Claims Quality Auditor
Los Angeles, CA · On-site
$31.51 - $62.64/hr
The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the ... Four or more years of medical claims payment experience in an HMO environment * Experience with CPT ...
Claims Quality Auditor
Los Angeles, CA · On-site
$31.51 - $62.64/hr
The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the ... Four or more years of medical claims payment experience in an HMO environment * Experience with CPT ...
Senior Specific Claims Auditor
$56K - $125K/yr
Will be assigned more claims than an auditor, as needed. What You Bring ... Strong medical knowledge including International Classification of Diseases (ICD), Current ...
Senior Specific Claims Auditor
$56K - $125K/yr
Will be assigned more claims than an auditor, as needed. What You Bring ... Strong medical knowledge including International Classification of Diseases (ICD), Current ...
... medical (physician) group, home healthcare services and hospice care, as well as heart, cancer ... Claims auditing and understanding claims processing in a claims department * Experience with ...
... medical (physician) group, home healthcare services and hospice care, as well as heart, cancer ... Claims auditing and understanding claims processing in a claims department * Experience with ...
Medical Claims Auditor information
See salary details
$14.66 - $17.88
24% of jobs
$17.98 is the 25th percentile. Wages below this are outliers.
$17.88 - $21.09
40% of jobs
$21.09 - $24.30
10% of jobs
$24.60 is the 75th percentile. Wages above this are outliers.
$24.30 - $27.51
8% of jobs
$27.51 - $30.73
0% of jobs
$30.73 - $33.94
0% of jobs
$33.94 - $37.15
0% of jobs
$37.15 - $40.36
0% of jobs
$40.36 - $43.58
0% of jobs
$43.58 - $46.79
10% of jobs
$46.79 - $50
7% of jobs
$14
$25
$50
How much do medical claims auditor jobs pay per hour?
As of Sep 4, 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 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.
What is the difference between Medical Claims Auditor vs Medical Billing Specialist?
| Aspect | Medical Claims Auditor | Medical Billing Specialist |
|---|---|---|
| Credentials | Certification (e.g., CPC, CCA), relevant experience | Certification (e.g., CPC), relevant experience |
| Work Environment | Insurance companies, healthcare facilities, auditing firms | Medical offices, billing companies, healthcare providers |
| Job Focus | Reviewing and verifying insurance claims for accuracy and compliance | Preparing 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.
More about Medical Claims Auditor jobs
What cities are hiring for Medical Claims Auditor jobs?
Cities with the most Medical Claims Auditor job openings:
Who are the top companies hiring for Medical Claims Auditor jobs?
The top employers for Medical Claims Auditor jobs are:
What states have the most Medical Claims Auditor jobs?
States with the most job openings for Medical Claims Auditor jobs include:
What job categories do people searching Medical Claims Auditor jobs look for?
The top searched job categories for Medical Claims Auditor jobs are:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 14 days ago
Elevance Health rating
7.5
Based on 354 frontline employees who took The Breakroom Quiz
218th of 315 rated insurance
Job description
Anticipated End Date:
2026-09-11Position Title:
Claims Auditor LeadJob Description:
Claims Auditor Lead
Hybrid 1: This role requires associates to be in-office1 - 2days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unlessaccommodationis granted as required by law.
The Claims Auditor Lead is responsible for processing high dollar claims within Service Operations. Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy. Serves as the subject matter expert for the unit.
Primary duties may include, but are not limited to:
Responsible for all team training including but not limited to new hires, cross training, new product and system enhancements.
Conducts audits for new hires and/or any team member learning a new skill.
Reviews, interprets and maintains records of quality and productivity for entire team.
Coaches, mentors and develops associates to ensure processes, guidelines and tools are utilized correctly.
Utilizes inventory management strategies to monitor priorities and ensure timely turnaround of all claims.
Responsible for creating, updating and maintaining departmental policy and claims auditor procedure manuals for accuracy.
Independently analyzes and makes decisions on complex claim audit issues.
Serves as subject matter expert on policy, workflow and technical questions.
Interfaces with all levels of support including but not limited to production support, medical management, provider /vendor contracting and other audit teams.
Partners with Management on complex claims reviews and resolution.
Responsible for reviewing and resolving shared mailbox issues.
Interprets contracts, prepares monthly reports, and attends meetings as subject matter expert when requested.
Manages projects as assigned and may work across different platforms or lines of business.
Reviews and responds to external audit requests.
Performs audit reviews of and may adjudicate complex high dollar claims by completing an end to end audit with final approval authority.
Minimum Requirements:
Requires a HS diploma or GED and a minimum of 6 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background.
Preferred Requirements:
Proficiency in Microsoft Office Suite is highly preferred.
Commercial Claims experience is highly preferred
CI&W and WGS experience is highly preferred.
Job Level:
Non-Management ExemptWorkshift:
1st Shift (United States of America)Job Family:
CLM > Claims SupportPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.
What Elevance Health employees say
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About Elevance Health
Sourced by ZipRecruiter
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Indianapolis, IN, US
Year founded
2004