Senior Claims Auditor
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Senior Claims Auditor handling high-complexity claims reviews at Risk Strategies. Ensuring compliance and adherence to procedures with focus on analytics and collaboration.
Responsibilities:
- Perform in-depth claims file reviews for accuracy and compliance
- Document findings and provide recommendations for corrective action
- Identify trends and collaborate with departments to improve claim practices
- Support audit reporting and analytics
Requirements:
- Bachelor's degree preferred; CPCU, AIC, or other insurance certifications a plus
- 4 - 6 years of claims or audit experience
- Strong understanding of claims handling and insurance regulations
- Analytical, organized, and skilled in Excel/audit systems
Benefits:
- medical
- dental
- vision
- disability
- life insurance
- retirement savings
- paid time off
- paid holidays

Risk Strategies Company
InsuranceA Specialist Approach
Similar Jobs

Part-Time Financial Compliance Auditor – AML/CFT
Part-time financial compliance auditor examining Honduran regulated entities’ AML/CFT controls. Testing KYC, transaction monitoring, sanctions screening, evidence, findings, and remediation.

AI Task Auditor, Freelance AI Trainer
SWE-Bench AI task auditor reviewing software-engineering tasks for Meridial’s AI training and evaluation systems. Providing technical audits, reproducibility checks, and actionable codebase feedback.

Kubernetes AI Task Auditor, Freelance AI Trainer
Kubernetes AI task auditor evaluating technical training tasks for AI systems. Providing actionable feedback on orchestration, configuration, testing, and logic accuracy.

Risk Adjustment, HCC Coder, Auditor
HCC Auditor validating risk-adjustment codes and medical records for e4health healthcare clients. Reporting audit results and training coders and providers remotely.

Facility Coding Auditor
ASC coding auditor reviewing medical records and coding data for healthcare facilities. Identifying compliance risks, reducing denials, and improving reimbursement accuracy.

LPN – Notice Of Action Letter Auditor
LPN auditing notice-of-action letters for CVS Health’s healthcare services operations. Applying clinical guidelines to ensure timely, accurate member and provider communications.

Stop Loss Claim Auditor Intern
Stop-loss claim auditing intern supporting CTI Audit Solutions' healthcare claims audits. Reviewing documentation, analyzing medical data, and preparing audit findings remotely.

Internal Process Auditor
Internal Process Auditor ensuring ISO 9001:2015 compliance across KAIZEN’s PPM, AMC, and building insurance services. Leading audits, risk management, QMS improvements, and corrective actions.

Claims Auditor
Claims Auditor reviewing managed-care claims and reporting processing errors for Providence healthcare network. Ensuring data integrity, adjudication accuracy, and regulatory compliance.

Senior Inpatient Coding Auditor
Inpatient coding auditor reviewing medical records, diagnoses, procedures, and DRG assignments. Supporting Gainwell’s healthcare solutions through compliant audits, documentation, and coder training.

Associate REMS Auditor
Associate REMS Auditor supporting stakeholder audits, documentation review, and FDA/REMS compliance. UBC provides pharmaceutical support services across drug development and commercialization.

REMS Compliance Auditor
REMS Auditor supporting pharmaceutical compliance audits for UBC’s drug development and commercialization services. Reviewing stakeholder documentation, recording findings, and supporting regulatory-quality initiatives.

Internal Auditor
Internal Auditor validating GRC controls and evidence for Workstreet’s cybersecurity compliance programs. Conducting ISO, HIPAA, and GDPR audits for global clients.

Inpatient Coding Auditor
Inpatient coding auditor ensuring accurate, compliant hospital coding for OU Health. Auditing coder work, validating DRGs, and delivering targeted education.

Claims Auditor
Claims Auditor auditing medical billing accuracy and compliance for MedPOINT Management, an IPA healthcare management company. Identifying payment discrepancies and improving claims operations remotely.

Senior Insurance Auditor
Senior insurance auditor conducting physical and remote audits for EXL, a data analytics and digital operations company. Reviewing business records, interviewing insureds, and preparing carrier reports.

Coding Auditor
Professional Coding Auditor auditing clinical documentation and CPT/ICD-10 coding for WellStreet Urgent Care. Improving compliance, charge capture, reimbursement, and provider coding quality.

Coding Auditor
Professional Coding Auditor auditing CPT and ICD-10 coding for WellStreet Urgent Care. Educating providers and coders while improving documentation, compliance, charge capture, and reimbursement.

Medical Review Auditor – Fraud Waste and Abuse
Medical Review Auditor auditing medical records and healthcare claims for Cotiviti’s Fraud, Waste & Abuse clients. Evaluating coding accuracy, policy compliance, and suspicious documentation patterns.

Risk Adjustment Auditor – Educator
Centene risk adjustment auditor educator improving healthcare coding accuracy for Georgia and Florida providers. Auditing records, analyzing MRA data, and training contracted healthcare providers.