Senior Healthcare Claims Auditor

Job Summary

Leading comprehensive claims quality and compliance programs, the full-time Senior Healthcare Claims Auditor will execute audits of healthcare claims, identify root causes of errors, and collaborate with cross-functional teams to enhance operational excellence in a remote environment.

Key Responsibilities

• Design and implement an enterprise claims quality assurance program focused on defect reduction and operational excellence
• Perform comprehensive audits of various healthcare claims to validate adjudication accuracy and regulatory adherence
• Collaborate with operational teams to identify automation opportunities that improve claims processing efficiency

Required Qualifications

• Bachelor's degree in Healthcare Administration, Business, Health Information Management, or related field
• 7+ years of healthcare claims operations, auditing, or quality assurance experience within a health plan or payer environment
• Strong experience auditing Commercial, Medicare, and/or Medicaid claims
• Experience supporting regulatory audits and compliance initiatives
• Deep understanding of healthcare claims lifecycle and adjudication processes