claims auditor

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

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

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)

Gallagher

<div>Introduction 
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div> 
Overview<div> 
Role specifics:</div><div>
Jurisdictions: United States</div><div>
Location: This role is eligible for fully remote work.</div><div> 
Professional designations such as Certified Fraud Examiner (CFE) or similar is preferred. This role will not have direct reports.</div><div></div> 
We are seeking a highly analytical and professionally skeptical Deepfake Specialist specializing in Workers&rsquo; Compensation and Liability claims. In this role, you will audit high‑risk payments to identify potential fraud, errors, and non‑compliance with GB Best Practices. Your work directly supports the integrity of our claims payment processes and supporting our commitment to delivering exceptional service to our clients.<div> 
Required Qualifications</div><ul><li>
Associate degree in a related field.</li><li>
5&ndash;7 years of experience in claims auditing, Workers&rsquo; Compensation, Liability claims, or a closely related discipline.</li><li>
Strong understanding of Workers&rsquo; Compensation and Liability regulations, claims processes, and industry standards.</li></ul>
 
How you'll make an impact<div> 
Key Responsibilities</div><ul><li>
Conduct detailed audits of Workers&rsquo; Compensation and Liability claim payments with a strong fraud‑risk mindset and professional skepticism to identify, investigate, and escalate potential internal fraud, errors, and non-compliance with GB Best Practices.</li><li>
Review supporting documentation&mdash;including invoices, medical bills, and settlement agreements&mdash;for accuracy, appropriateness, and alignment with policy.</li><li>
Collaborate with adjusters, managers, and cross‑functional teams to resolve discrepancies and implement corrective actions.</li><li>
Maintain current knowledge of jurisdictional regulations, industry trends, and best practices relevant to Workers&rsquo; Compensation and Liability claims.</li><li>
Contribute to the development and enhancement of audit procedures to improve audit quality, consistency, and effectiveness.</li><li>
Participate in special projects or process improvement initiatives as needed.</li></ul>
 
About You<div> 
Required Qualifications</div><ul><li>
Associate degree in a related field.</li><li>
5&ndash;7 years of experience in claims auditing, Workers&rsquo; Compensation, Liability claims, or a closely related discipline.</li><li>
Strong understanding of Workers&rsquo; Compensation and Liability regulations, claims processes, and industry standards.</li><li>
Demonstrated analytical skills with exceptional attention to detail and accuracy.</li><li>
Proficiency with audit software and Microsoft Office (especially Excel).</li><li>
Strong written and verbal communication skills.</li><li>
High ethical standards and the ability to consistently apply professional skepticism.</li><li>
Ability to work both independently and collaboratively.</li></ul><div></div><div> 
#LI-NZ1</div><div>
#REMOTE</div> 
 
Compensation and benefits 
We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.
Below are the minimum core benefits you&rsquo;ll get, depending on your job level these benefits may improve:
<ul><li>Medical/dental/vision plans, which start from day one!</li><li>
Life and accident insurance</li><li>
401(K) and Roth options</li><li>
Tax-advantaged accounts (HSA, FSA)</li><li>
Educational expense reimbursement</li><li>
Paid parental leave</li></ul><div>
Other benefits include:</div><ul><li>
Digital mental health services (Talkspace)</li><li>
Flexible work hours (availability varies by office and job function)</li><li>
Training programs</li><li>
Gallagher Thrive program &ndash; elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing</li><li>
Charitable matching gift program</li><li>
And more...</li></ul><div>
**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.</div><div></div><div> 
We value inclusion and diversity</div>
Click Here to review our U.S. Eligibility Requirements
Inclusion and diversity (I&amp;D) is a core part of our business, and it&rsquo;s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees&rsquo; diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as &ldquo;protected characteristics&rdquo;) by applicable federal, state, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.</div>

Deepfake Specialist

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

Freedom Mortgage

<div>Summary:
The Analyst, Loss Analysis is responsible for the QC, audit and oversight of claims filed. It is the Analyst&rsquo;s duty to ensure that all claims comply with investor and insurer requirements and assist in the reduction of loss exposure to the Company. The Analyst will provide claims loss analysis reports weekly, monthly or as determined by management. In instances where a claims error is identified, a supplemental claim will be filed by the Analyst.
Essential Job Functions may include:<ul><li>
Complete loss analysis reviews to safeguard the servicer&rsquo;s assets and insure compliance with insurer requirements</li><li>
Analyze and rebut insurer curtailments for all government insured filed claims, including but not limited to conveyance, claims for advances, loss mitigation and non conveyance claims</li><li>
Quality Control review for Default Claims, including supplemental claims to reduce loss exposure and provide loss analysis reports</li><li>
Assist in compiling claims data for government claims audits, in addition reviewing auditors findings and providing rebuttal responses</li><li>
Complete monthly write offs of remaining balances once all claims and supplemental funds received on an account</li><li>
Act as a subject matter expert to the claims department to insure compliance on all claims filings</li><li>
Correspond with vendors and site employees</li><li>
Act as a point of contact/liaison, ensuring that policies and procedures relating to invoicing and remittance are followed, including compliance with federal laws and regulations</li><li>
Demonstrates professional behavior and teamwork, is punctual, dependable and adheres to Company policies and procedures</li><li>
Ability to work necessary hours to ensure success</li><li>
Maintain regular and punctual attendance.</li></ul>
Other Duties could include:
Performs other related duties as assigned.
Supervisory Responsibilities:
This job has no supervisory responsibilities.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.<ul><li>
Strong understanding of FHA, VA and GSE claims guidelines</li><li>
Excellent organization skills</li><li>
Attention to detail with a high level of accuracy</li><li>
Excellent communication skills</li><li>
Analytical and Problem Solving skills</li><li>
Works well in a team environment</li><li>
Ability to meet deadlines in a fast paced environment</li><li>
Ability to manage time well and prioritize tasks</li><li>
Microsoft Office experience and advanced Excel knowledge</li><li>
Ability to effectively present information to supervisory, etc.</li><li>
Ability to write reports and correspondence</li><li>
Ability to read, analyze and interpret documents such as technical journals, financial reports, legal documents, policies and procedures</li><li>
Ability to calculate basic financial figures and amounts</li><li>
Proficient in computer skills and knowledge of word processing, spreadsheet, accounting, general ledger, accounts receivable, accounts payable, e-mail and internet software</li><li>
Ability to define problems, collect data, establish facts, and draw valid conclusions</li><li>
Ability to work with little supervision.</li><li>
Ability to meet critical departmental and federal timelines with accuracy and efficiency.</li><li>
Ability to build relationships with both internal and external clients/vendors.</li><li>
Strong work and business ethics</li></ul>
Education and/or Experience:<ul><li>
High School diploma or equivalent required.</li><li>
Bachelor&rsquo;s Degree from a Four (4) year College or University preferred.</li><li>
Minimum of five years of experience in the rebuttal of compensatory fees and curtailments process, investor claims processing, auditing and loss analysis reporting; or equivalent combination of education and experience.</li><li>
An in-depth understanding of all government regulations pertaining to claims filing and reimbursement.</li></ul>
Language Skills:
Ability to read and comprehend instructions, correspondence, memos, and work place policies. Ability to analyze, interpret general business periodicals, professional journals, procedures and governmental regulations. Ability to write professional correspondences. Ability to write routine business reports. Ability to speak effectively with other employees and/or customers. Ability to present formal information in one-on-one and small group situations to customers and employees. Ability to present information and respond to questions from groups of administrators, managers, employees, customers and/or the general public.
Mathematical Skills:
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Reasoning Ability:
Ability to carry out detailed written and/or verbal instructions. Ability to solve problems involving concrete variables in standardized situations. Ability to define problems collects data, establish facts, and draw valid conclusions.
Certificates, Licenses, Registrations:
None required.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is normally performed in a typical interior office work environment which does not subject the employee to any hazardous or unpleasant elements. The noise level in the work environment is usually moderate.
Equal Employment Opportunity:
Freedom Mortgage is committed to providing equal employment opportunities to all employees and applicants without regard to race, ethnicity, color, sex, marital status, sexual orientation, gender identity or expression, pregnancy, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws.
Americans with Disabilities Act:
Applicants as well as employees who are or become disabled must be able to satisfactorily perform the essential job functions of the position either with or without reasonable accommodation. Applicants as well as employees are encouraged to meet with Human Resources as the organization shall review reasonable accommodations on a case-by-case basis in accordance with applicable law.
Job Responsibilities:<div><div>
The statements reflect the general duties and responsibilities considered necessary to perform the essential functions of the job and should not be considered as an all-inclusive list of all the work requirements of the position. Freedom Mortgage Corporation may change the specific job duties with or without prior notice based on the needs of the organization.</div></div></div>
 
Remote

Analyst, Loss Analysis (USDA)

The Acadian Companies

<div>Acadian Client Services has an immediate opening for a full-time Vendor Management Billing Specialist to join their team in Lafayette, LA.

Job Location: Lafayette, LA - This position is based in the office, Monday-Friday, 8:00am-5:00pm. This is NOT a Work from Home position.

Summary of Duties: The Vendor Management Billing Specialist is responsible for auditing and increasing the quality standards within the revenue cycle department by reviewing claims processes, billing protocols, and write off protocols are followed according to established policies. This position will independently review claims and make recommendations to senior leadership on process improvements or educational opportunities.

Essential Functions:
<ul>
<li>Responsible for claim status checks as needed to ensure proper resolution</li>
<li>Initiating contact with insurance providers as needed</li>
<li>Review and process claim rejections and appeals for research and resolution</li>
<li>Monitor payment discrepancies and process payments</li>
<li>Review claims for Federal compliance</li>
<li>Process incoming correspondence and phone calls specific to the payer type</li>
<li>Verification of patient insurance</li>
<li>Ensure accuracy of demographic information</li>
<li>Other duties and responsibilities as assigned</li>
</ul>
Qualifications:
<ul>
<li>High school diploma or equivalent</li>
<li>Previous medical billing experience preferred</li>
<li>Proficient in Google, MS Office Suite or related software</li>
<li>Possess strong organizational skills</li>
<li>Punctual with strong attendance history</li>
<li>Ability to adhere to productivity goals, departmental and company guidelines, dress code, policy and procedures</li>
<li>Excellent interpersonal skills and time management</li>
<li>Maintain highest level of confidentiality</li>
</ul>
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. 
 
Req Benefits: We offer comprehensive insurance benefits for full-time employees, including but not limited to Medical, Dental, Vision coverages, along with 401(k) and ESOP (Employee Stock Ownership Program), and Vacation and Sick time.</div>

Billing Specialist (Vendor Management)

Search 2077+ Claims auditor jobs near you this May. New roles added regularly across leading industries. Apply today.