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Remote 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 ... Remote Work Requirements: To ensure reliable performance on the company-issued CODOXO laptop ...

Vytwo

SW Engineer (DevOps)

Prosper, TX · Remote

$54 - $74/hr

... our legacy claim auditing system. Youll analyze the needs and the environment to make sure the ... This is a remote position.

Broadway Ventures

Medical Claim Reviewer (CGS, DMEC)

Medical Claim Reviewer (CGS, DMEC) At Broadway Ventures, we transform challenges into opportunities ... Remote (U.S. - Work from home) Remote Work Requirements: High-speed internet (non-satellite) and a ...

RiteChoice Rx

Claims Auditor

Pharmacy auditing, medical billing auditing, or pharmacy technician experience is strongly ... This position is remote, with occasional travel to the corporate office. Essential Job Duties

Humana, Inc.

Medical Coding Auditor

Complete appropriate system(s) entry regarding claim/encounter information * Support and ... Remote, work at home. While this is a remote position, occasional travel to Humana's offices for ...

CEI

LPN/Medical Reviewer - Remote

Columbia, SC · Remote

$22.25 - $30.25/hr

... fully remote Must have an active LPN License. M-F 8-5 Pay 23/hr Description - * Performs medical ... Performs medical claim reviews and makes a reasonable charge payment determination. Monitors ...

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · On-site +1

Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ... Medical, Dental, Vision, Life, HSA, 401(k) * Paid Time Off (PTO) * 7 paid holidays * A supportive ...

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · Remote

Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ... Medical, Dental, Vision, Life, HSA, 401(k) * Paid Time Off (PTO) * 7 paid holidays * A supportive ...

ImageNetLLC

Claims Quality Auditor - Remote

Tampa, FL · Remote

Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ... Medical, Dental, Vision, Life, HSA, 401(k) * Paid Time Off (PTO) * 7 paid holidays * A supportive ...

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Remote Medical Claim Auditor information

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How much do remote medical claim auditor jobs pay per hour?

As of Jul 6, 2026, the average hourly pay for remote 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.

What are the key skills and qualifications needed to thrive as a Remote Medical Claim Auditor, and why are they important?

To thrive as a Remote Medical Claim Auditor, you need a solid understanding of medical billing and coding, healthcare regulations, and insurance claims processes, often supported by a degree in health information management or a related field. Familiarity with auditing software, electronic health records (EHR) systems, and certifications such as CPC (Certified Professional Coder) or CPMA (Certified Professional Medical Auditor) are typically required. Strong attention to detail, analytical thinking, and effective communication skills help auditors identify discrepancies and collaborate with healthcare providers. These skills and qualifications are vital for ensuring accuracy, compliance, and cost savings in healthcare reimbursement.

How do Remote Medical Claim Auditors typically collaborate with healthcare providers and insurance teams while working off-site?

Remote Medical Claim Auditors routinely engage with healthcare providers and insurance teams through secure digital platforms, email, and virtual meetings. They review claims data, clarify documentation, and resolve discrepancies by communicating directly with billing departments and insurance representatives. Effective collaboration relies on clear, timely communication and a strong understanding of compliance regulations. While working independently, auditors are still part of a broader team, often participating in regular check-ins and process improvement discussions.

What does a Remote Medical Claim Auditor do?

A Remote Medical Claim Auditor reviews and evaluates healthcare claims to ensure accuracy, compliance with regulations, and proper documentation. They work from a remote location, analyzing medical records and billing information to identify errors, fraud, or overpayments. Their goal is to ensure that healthcare providers and insurance companies process claims correctly and adhere to industry standards. This role often involves communicating findings, recommending corrective actions, and sometimes working with multiple software systems. Attention to detail and knowledge of medical coding and billing practices are essential for success in this position.

What is the difference between Remote Medical Claim Auditor vs Remote Medical Billing Specialist?

AspectRemote Medical Claim AuditorRemote Medical Billing Specialist
CredentialsCertifications like CPC, CPC-H, or equivalentCertifications like CPC, CPC-H, or equivalent
Work EnvironmentHealthcare insurance companies, third-party administrators, or healthcare providersMedical offices, billing companies, or healthcare providers
Job FocusReviewing and auditing insurance claims for accuracy and compliancePreparing and submitting insurance claims, following up on payments

Both roles require similar certifications and often operate within healthcare or insurance environments. The key difference is that Remote Medical Claim Auditors focus on reviewing claims for accuracy and compliance, while Remote Medical Billing Specialists handle the submission and management of claims. Understanding these distinctions helps job seekers identify the right role based on their skills and career goals.

More about Remote Medical Claim Auditor jobs
What cities are hiring for Remote Medical Claim Auditor jobs? Cities with the most Remote Medical Claim Auditor job openings:
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What states have the most Remote Medical Claim Auditor jobs? States with the most job openings for Remote Medical Claim Auditor jobs include:
What job categories do people searching Remote Medical Claim Auditor jobs look for? The top searched job categories for Remote Medical Claim Auditor jobs are:
Remote Medical Claim Auditor jobs near you
Claim Auditor Payment Integrity (44544)

Claim Auditor Payment Integrity (44544)

Neighborhood Health Plan of Rhode Island

Smithfield, RI • Remote

Full-time

Posted 19 days ago

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 three (3) years of claim review work experience to equate to the degree
  • American Academy of Professional Coder’s (AAPC) CPC certification or similar 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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