Conduct pre-, post-payment and auto-adjudication audits for routine to moderate claims
Verify processing, payment and financial accuracy per SPDs, regs and SOPs
Meticulously track and report audit results for reporting and trends
Identify corrections and verify adjustments are complete and accurate
Identify trends from quality reviews and drive root-cause improvements
Investigate claim issues to improve standard processing guidelines

🎯 Requirements

Bachelor’s Degree or equivalent work experience
2 years auditing medical claims for a health insurer or TPA
Extensive (5 years) medical claims processing background
Ability to analyze data and identify trends; apply 5 Whys for root cause
Core system configuration knowledge
Ability to articulate findings and defend methodology

🎁 Benefits

Alternative medicine coverage
Flexible PTO
Up to 16 weeks paid parental leave
Paid holidays
401k program
Transportation perks

Apply on employer's website

This employer gathers applications via their own applicant tracking system.

You will be redirected to an external application form.

Share job

Meet JobCopilot: Your Personal AI Job Hunter

Automatically Apply to Healthcare Jobs. Just set your preferences and Job Copilot will do the rest — finding, filtering, and applying while you focus on what matters.

Activate JobCopilot