claim auditor

Southwest Service Administrators

<div>The Claims Auditor is responsible for all audit activities for medical and/or dental claims while supporting the team manager to create, maintain and provide statistical audit reports and documentation.
Responsibilities
Auditing &amp; Reporting<ul><li>
Gain and maintain the understanding of the plan designs and effectively apply that knowledge.</li><li>
Maintain a comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits and turnaround times across all product lines</li><li>
Research claim processing issues to determine the origin and appropriate resolution</li><li>
Prepare reports for management summarizing observations and recommendations</li><li>
Assist in testing system functionality during upgrades and implementations</li></ul>
Teamwork<ul><li>
Work cooperatively with other team members</li><li>
Actively participate in team meetings and training activities.</li><li>
Perform additional responsibilities and projects as periodically assigned.</li></ul>
Education/Certification:<ul><li>
High School Diploma/GED</li><li>
Three (3) years recent experience analyzing medical claims</li></ul>
Skills/Abilities:<ul><li>
Ability to maintain production and quality standards.</li><li>
Extensive knowledge of medical terminology, CPT Codes, ICD 9/10 and medical claim forms.</li><li>
Ability to read, analyze and assess medical documentation and draw valid conclusions.</li><li>
Minimum 40 WPM and 3,000 KPH proficiency</li><li>
Solid knowledge of MS Excel &amp; MS Word</li><li>
Professional, client-focused approach to colleagues and assignments.</li><li>
Strong oral and written communication skills with exceptional attention to details.</li><li>
Ability to seek out experiences that may change perspective or provide an opportunity to learn new things.</li><li>
Strong dedication to follow-through on all tasks and assignments.</li><li>
Ability to organize, set priorities, work independently and complete multiple projects within established deadlines.</li><li>
Ability to sit for long periods of time operating a computer keyboard.</li></ul>
Employee Benefits Program
COMPANY PROVIDES:<ul><li>
MEDICAL, DENTAL, VISION</li><li>
SHORT-TERM DISABILITY</li><li>
Full coverage benefits for a low weekly premium of $5 (Employee Only), $15 (for Child(ren) and $20 per week for full family or Employee/Spouse.</li><li>
COMPANY PAID supplemental dental coverage of $1,000 per year for Employee.</li><li>
COMPANY PAID LONG TERM Disability &amp; Life/AD&amp;D coverage.</li><li>
401K Plan including company match up to 5%.</li><li>
COMPANY PAID additional pension plan entirely funded by the company.</li><li>
EXCEPTIONAL TIME OFF package including Paid Personal Leave (PPL) and Vacation with annual BUY BACK options!!!!</li><li>
Annual, automatic pay increases.</li></ul>
Southwest Service Administrators provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, or any other considerations made unlawful by applicable state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence compensation and training. Southwest Service Administrators expressly prohibits any form of workplace harassment based on race, color, religion, sex, national origin, pregnancy, military and veteran status, age physical and mental disability, or genetic characteristics.</div>

Auditor (Claims)

Hoag Health System

<div>Primary Duties and Responsibilities
The Claims Auditor is responsible for performing pre-payment and post-payment audits ensuring financial and processing accuracy, compliance with regulatory and health plan requirements of claims processed.
The Claims Auditor is responsible for auditing and confirming accuracy of the loading of:
<ul><li>Fee schedules
</li><li>Provider contracts
</li><li>Payor contracts
</li><li>Benefits
</li><li>Code changes
</li><li>System enhancements</li></ul></div>
 <div>Education and Experience
<ul><li>High School Diploma or equivalent
</li><li>5 years of experience in a medical claims processing environment
</li><li>Knowledge of HMO/managed care regulatory guidelines
</li></ul>Preferred:
<ul><li>Experience with Epic Tapestry system
</li><li>3 years experience in claim audits, revenue recovery, or claims system configuration
</li></ul>License Required
N/A
License Preferred
N/A
Certifications Required
N/A
Certifications Preferred
N/A</div>

Claims Auditor: Hoag Clinic Claims & Enrollment

Central Ky Motorsports

Job Opportunity: Inventory AuditorLocation: Muscat, Oman Company: Central Ky MotorsportsAbout UsCentral Ky Motorsports is a leading motorsports and automotive solutions provider, delivering high-performance products and services across Oman. With a strong commitment to precision, efficiency, and operational excellence, we ensure that our inventory systems support seamless business operations. To strengthen our corporate team in Muscat, we are seeking a detail-oriented Inventory Auditor to oversee inventory accuracy and compliance.Role OverviewThe Inventory Auditor will be responsible for monitoring, verifying, and reconciling inventory records to ensure accuracy and compliance with company standards. This role requires strong analytical skills, attention to detail, and the ability to collaborate with operations and finance teams.Key Responsibilities<ul><li>Conduct regular audits of inventory across warehouses and retail outlets.</li><li>Verify stock levels, reconcile discrepancies, and ensure accurate reporting.</li><li>Collaborate with procurement, logistics, and finance teams to streamline inventory processes.</li><li>Prepare audit reports and present findings to management.</li><li>Ensure compliance with company policies and regulatory standards.</li><li>Identify risks, inefficiencies, and recommend corrective actions.</li><li>Support system improvements and automation initiatives for inventory management.</li><li>Assist in training staff on inventory control procedures.</li></ul>Qualifications<ul><li>Bachelor&rsquo;s degree in Accounting, Finance, Supply Chain, or related field.</li><li>3&ndash;5 years of experience in inventory auditing, accounting, or logistics.</li><li>Strong knowledge of inventory management systems and auditing practices.</li><li>Proficiency in MS Excel and ERP software.</li><li>Excellent analytical, organizational, and communication skills.</li><li>Ability to manage multiple priorities in a fast-paced environment.</li><li>Fluency in English; Arabic is a strong advantage.</li></ul>Why Join Us?<ul><li>Be part of a respected motorsports and automotive solutions provider in Oman.</li><li>Gain valuable experience in inventory auditing and compliance.</li><li>Competitive salary and benefits package.</li><li>Opportunities for career growth and skill development.</li><li>Collaborative, innovative, and performance-driven work culture.</li></ul>Job Type: Full-timePay: Up to RO1,450.000 per monthWork Location: In person

Inventory Auditor

JS Bank

<div>
 
 
 We&rsquo;re Hiring | SQ Auditor
 
 
 
 
 Location: Sialkot
 
 
 
 
 Line of Business: Customer Experience
 
 
 
 
 Grade: OG I &ndash; AVP
 
 
 
 
 Positions: 01
 
 
 
 At
 
 JS Bank
 
 , we are looking for a dynamic and detail-oriented
 
 SQ Auditor
 
 to join our
 
 Customer Experience
 
 team in
 
 Sialkot
 
 .
 
 
 
 Eligibility Criteria:
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree in Business Administration or a related field
 </li>
 <li>
 Minimum 1 year of banking experience preferred
 </li>
 <li>
 Fresh graduates are also encouraged to apply
 </li>
 </ul>
 
 
 Role Overview:
 
 
 
 The incumbent will support service quality initiatives by evaluating customer interactions, branch environment, and service delivery standards across assigned branches. The role will also act as an
 
 Ethics/Conduct Officer
 
 , identifying unethical practices through customer complaints, fraud incidents, direct feedback, and surprise branch visits.
 
 
 
 Key Responsibilities:
 
 
 <ul>
 <li>
 Conduct service quality audits and surprise branch visits
 </li>
 <li>
 Assess customer experience and branch service standards
 </li>
 <li>
 Identify service gaps and recommend corrective actions
 </li>
 <li>
 Review customer complaints and feedback trends
 </li>
 <li>
 Report observations related to service quality, ethics, and conduct
 </li>
 </ul>
 
 If you are passionate about customer experience and want to grow your career with
 
 JS Bank
 
 , we encourage you to apply.
 
 
 
 Location: Sialkot
 
 
</div>

SQ Auditor

DINERS

Job Title: Inventory AuditorLocation: RawalpindiKey Responsibilities:<ul><li>Conduct physical inventory audits at stores and warehouses.</li><li>Compare system inventory records with actual stock levels.</li><li>Identify, investigate, and report discrepancies in stock counts.</li><li>Ensure compliance with company inventory policies and procedures.</li><li>Generate and analyze inventory reports to detect patterns of shrinkage or overstock.</li><li>Work with store managers and warehouse teams to address inventory variances.</li><li>Collaborate with operations and supply chain teams to improve inventory accuracy.</li><li>Support implementation of new inventory control procedures.</li><li>Ensure all stock transactions follow company SOPs and retail compliance guidelines.</li><li>Maintain audit records and ensure proper documentation of stock adjustments.</li></ul>Qualifications &amp; Skills:<ul><li>01 to 2+ years of experience in inventory auditing, retail operations.</li><li>Strong knowledge of inventory management systems.</li><li>Proficiency in Microsoft Excel and data analysis tools.</li><li>Excellent attention to detail and problem-solving skills.</li><li>Strong communication and reporting skills.</li><li>Ability to travel to different retail locations as required.</li><li>Experience in the fashion retail industry.</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs60,000.00 per monthWork Location: In person

Job Title: Inventory AuditorLocation: LahoreKey Responsibilities:<ul><li>Conduct physical inventory audits at stores and warehouses.</li><li>Compare system inventory records with actual stock levels.</li><li>Identify, investigate, and report discrepancies in stock counts.</li><li>Ensure compliance with company inventory policies and procedures.</li><li>Generate and analyze inventory reports to detect patterns of shrinkage or overstock.</li><li>Work with store managers and warehouse teams to address inventory variances.</li><li>Collaborate with operations and supply chain teams to improve inventory accuracy.</li><li>Support implementation of new inventory control procedures.</li><li>Ensure all stock transactions follow company SOPs and retail compliance guidelines.</li><li>Maintain audit records and ensure proper documentation of stock adjustments.</li></ul>Qualifications &amp; Skills:<ul><li>01 to 2+ years of experience in inventory auditing, retail operations.</li><li>Strong knowledge of inventory management systems.</li><li>Proficiency in Microsoft Excel and data analysis tools.</li><li>Excellent attention to detail and problem-solving skills.</li><li>Strong communication and reporting skills.</li><li>Ability to travel to different retail locations as required.</li><li>Experience in the fashion retail industry.</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs60,000.00 per monthWork Location: In person

Trinity Health

Employment Type: 
Full time
 
Shift: 
Day Shift
 
Description: 
Position located in Westmont, Illinois - remote eligible. Benefit eligible (medical/dental) from the first day of employment.
 
Perform Quality Auditing of Claim Adjudicators and Customer Service Representatives. Audit capitation deductions, preparing summary of findings and disputes to the various HMOs. Review and respond to Stat Fax/Past Due Claim (PDC) inquiries from the HMOs.
 
<ul>
<li>Review claims for accuracy of information into the claims processing system and ensure Standard Operating procedures (SOPs) have been followed. Provide feedback to staff as errors are identified, including where procedures can be found on correct handling when appropriate.</li>
<li>Work closely with Operations Manager to identify areas requiring additional training, either on an individual basis or overall.</li>
<li>Review authorization/claim history to determine handling and appropriateness of deductions. Enter disputed deductions into Excel or Access, depending on the health plan. Review outstanding deductions and follow up with the health plan as needed. Update CHS files upon receipt of health plan’s response to indicate whether or not a credit was received.</li>
<li>Research, document and respond to HMO inquiries within appropriate time frames to avoid future capitation deductions. Responsible for contacting HMO for copies of claims that are not in claims processing system and require entry/adjudication. Responsible for contacting providers when claims have been processed to verify status of accounts.</li>
<li>Enhance department productivity by recommending improvements to the work flow processes and organizational structure. Contribute to team effort by accomplishing related results as determined by management. Attend meetings as necessary either internally or with the HMOs</li>
</ul>
Position Requirements: 
Minimum Education: 
Required: Associate Degree or 5-10 years of claims auditing and/or Managed care experience
 Preferred: Bachelor Degree
 Specify Degree(s): AAPC certification
 Residency: N/A
 
Minimum Experience: 
Required: 3-5 years of previous job-related experience
 Preferred: 6-10 years of previous job-related experience
 Details: Previous job related experience in a managed care environment, claims processing, claims auditing, analysis of claims errors. Familiarity with managed care products. Able to track errors and provide training if needed.
 
Licensure/Certifications: 
Preferred: Certified Professional Coder (AAPC)
 Other: RHIA, RHIT and AAPC
 
Required Skills: 
Ability to plan, coordinate and develop multiple projects
 
Compensation: 
Pay Range: $21.02 - 32.59 per hour
 Actual compensation will fall within the range but may vary based on factors such as experience, qualifications, education, location, licensure, certification requirements, and comparisons to colleagues in similar roles.
 Trinity Health Benefits Summary
 
Our Commitment
 
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

CLAIMS AUDITOR

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1228 claim auditor jobs Near Me

Auditor (Claims)

Claims Auditor: Hoag Clinic Claims & Enrollment

Inventory Auditor

SQ Auditor

Inventory Auditor

Inventory Auditor

CLAIMS AUDITOR