Healthcare Claims Auditor

Job Summary

A company is looking for a Healthcare Claims Auditor.

Key Responsibilities

• Review and verify insurance claims for accuracy, completeness, and compliance with policy terms and regulations
• Audit claim files and analyze payment accuracy, including complex claims
• Prepare audit documentation, reports, and summaries outlining findings and recommendations

Required Qualifications

• Experience reviewing and verifying healthcare insurance claims for accuracy and compliance
• Experience reviewing and interpreting EOB/EOP and Remittance Advice
• Prior experience conducting claim audits or payment accuracy analysis
• Knowledge of state and federal insurance regulations and compliance standards
• Ability to work independently in a remote environment while managing priorities and deadlines