Claims Auditor
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Job Description
Claims Auditor reviewing managed-care claims and reporting processing errors for Providence healthcare network. Ensuring data integrity, adjudication accuracy, and regulatory compliance.
Responsibilities:
- Maintain managed care health plan delegated auditing functions
- Review pre- and post-payment claims
- Document assigned errors
- Report claims processing errors
- Provide feedback to ensure compliance with health plans and regulatory agencies
- Conduct routine and complex audits to identify exceptions to claims adjudication requirements
- Secure data integrity and maintain accuracy standards for claims processing, payment, and procedural accuracy
- Report to the Supervisor, Claims Audit
Requirements:
- 3 years of claims processing experience in a managed care environment
- 1 year of claims audit experience (preferred)
- Experience processing Medicare, Medi-Cal, or One Care Connect claims (preferred)
- Knowledge of CMS, DMHC, and DHCS regulatory requirements
Benefits:
- Retirement 401(k) Savings Plan with employer matching
- Medical, dental, and vision health care benefits
- Life insurance
- Disability insurance
- Paid parental leave
- Vacation time
- Paid holidays
- Time off for health issues
- Voluntary benefits
- Well-being resources
- Additional compensation may be available, including shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities
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