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Medical Insurance Claim Auditor Jobs (NOW HIRING)

Cook Children's

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 ...

Cook Children's

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 ...

Cook Children's

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 ...

DMC Insurance, Inc.

Claims Auditor

Indianapolis, IN · On-site

We are seeking an experienced, highly motivated insurance professional to join our claims team. The Claim Auditor is responsible for auditing internal and external claim files for excess reporting ...

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Infographic showing various Medical Insurance Claim Auditor job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $53,259 per year, or $25.6 per hour.

Claim Auditor I

Fort Worth, TX • On-site

Cook Children's Health Care System
Health Care and Social Assistance • 5 - 10K employees
Learn more about Cook Children's Health Care Systemexternal

Full-time

Re-posted yesterday

Cook Children's Health Care System rating

7.9

Company rating: 7.9 out of 10

Based on 78 frontline employees who took The Breakroom Quiz

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.

About Us:
Cook Children's is an equal opportunity employer. As such, Cook Children's offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

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About Cook Children's Health Care System

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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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