claims auditor

Dubai Insurance TPA

1. JOB PURPOSEThe Auditor is responsible for external and internal audits and maintains the reports and processing DRG claims.2. RESPONSIBILITIES AND DUTIES&middot; Conducting Provider audit: Data analysis, Onsite visits for audits, preparing audit reports based on the analysis and onsite visit, Presentation of the findings during audit meetings, Closure of audits as per the FWA team process.&middot; Preparation of various reports in relation to the audits (Quarterly, HICAL, Audit log, finance team reports etc)&middot; Case Management of IP when referred&middot; Analysis and Feedback on triggers raised for OP , reimbursement claims&middot; Handling / responding the queries of Operations team (Claims, Approvals, Reimbursement, Customer care, Network) on Medical Coding (DRG, unbundling code, up coding, medically justify) when required.&middot; Interacting with other Teams (Claim Centre, Network Team and IT) on Medical coding, audits, etc.&middot; Reporting of various findings identified during audit that can affect or improve the process of operations team.&middot; Flagging or reporting of providers identified with FWA activity.3. KNOWLEDGE, SKILLS AND EXPERIENCE&middot; Bachelor&rsquo;s Degree (Nurse / Paramedical)&middot; American Medical Coding Education and certification.&middot; Experience in medical coding of 3-5 years&rsquo; within IP/OP and DRG claims.&middot; Industry knowledge (healthcare / insurance).&middot; Should be analytical, attentive to details and assertive.&middot; Excellent oral and written communication skills.&middot; Must be computer literate.&middot; Excellent command of the English language.Job Types: Full-time, PermanentPay: From AED8,000.00 per month

Medical Claims Auditor - Fraud waste

Dr. Joy Dental Clinic

Job SummaryWe are seeking a detail-oriented Insurance Auditor with a BDS qualification and hands-on experience in the UAE healthcare sector. The ideal candidate must have strong knowledge of DHA regulations, insurance coding protocols, and particularly CDT codes used in dental billing. This role will be responsible for auditing all insurance claims and treatment codes before submission to ensure accuracy, compliance, and timely approvals.Key Responsibilities<ul><li>Audit and verify all dental procedure codes (CDT, ADA, and DHA codes) before final submission to insurance providers.</li><li>Ensure claims comply with DHA guidelines, insurance policy requirements, and clinic protocols.</li><li>Review treatment plans and supporting documents for accuracy and completeness.</li><li>Identify discrepancies, errors, or misuse of codes and provide corrective actions.</li><li>Communicate with doctors, front desk, and billing teams to clarify documentation and coding queries.</li><li>Minimize claim rejections/denials by ensuring proper coding and documentation.</li><li>Stay updated with DHA, HAAD, MOH, and international insurance regulations, coding updates, and compliance requirements.</li><li>Provide internal training and guidance to staff on insurance coding and claim submission processes.</li><li>Prepare periodic reports on claim rejections, approvals, and audit findings for management review.</li></ul>Requirements<ul><li>Bachelor of Dental Surgery (BDS) is mandatory.</li><li>Minimum 2&ndash;3 years of experience in the UAE healthcare sector, preferably in a dental clinic.</li><li>Strong knowledge of DHA regulations and CDT codes.</li><li>Prior experience in dental insurance auditing, claim submissions, or coding.</li><li>Excellent analytical and attention-to-detail skills.</li><li>Strong communication and interpersonal abilities to coordinate with doctors and administrative teams.</li><li>Proficiency in dental practice management software and MS Office.</li></ul>Job Type: Full-timePay: AED1.00 - AED2.00 per monthApplication Question(s):<ul><li>Are you qualified Dentist? </li><li>Have you worked on CDT coding and Auditing?</li></ul>

Insurance Auditor

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary
The Claim Audit Quality Specialist will audit pre- and post-payment claims for accuracy and eligibility transactions. They will also be responsible for identifying errors, necessary corrective measures, and may participate in special audit assignments.
In this role, you will:<ul><li>
Work consistently out of a production queue, auditing any assigned claims.</li><li>
Oversee the completion several reviews a day, utilizing plan documents as a primary source.</li><li>
Utilize DG system to complete all reviews.</li><li>
Complete various tasks as assigned by team leads, and attend internal meetings as needed.</li><li>
Collaborate with internal account representatives and/or claims examiners as needed.</li></ul>
Required Qualifications<ul><li>
1+ year of experience working in a health care setting.</li><li>
At least 6 months of experience with interpreting and understanding of plan documents.</li><li>
Demonstrated knowledge of Microsoft Excel.</li></ul> 
Preferred Qualifications<ul><li>
1-2 years of claims processing experience.</li><li>
1-2 years of auditing experience.</li><li>
Ability to succeed in a production driven environment, managing multiple tasks while shifting priorities and maintaining a high work volume.</li><li>
Excellent verbal and written communication skills, with the ability to interact effectively and courteously.</li><li>
Ability to work with minimal guidance while delivering accurate and timely results.</li><li>
Strong time management, attention to detail, and organizational skills.</li><li>
Team-oriented personality.</li></ul> 
Education<ul><li>
High school diploma or GED.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$17.00 - $34.15
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits &ndash; investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul><li>
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li><li>
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li><li>
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li></ul>
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 03/04/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Claim Audit Quality Specialist

Medi Assist Insurance TPA Private Limited

Roles and Responsibilities01. Involves Processing of Claims / Preauth/ Audit ( Preauthorization / Reimbursement claims)02. Validating and processing claims / Auditing within TAT and Quality03. With good communication and medical Knowledge04. Complete / process the assigned claims within a dayFinancial : To see to that there is no financial implication for the organization while settlement of claimsRole : Medical OfficerRequired Knowledge /Skill : Good Medical knowledge to evaluate the treatment planEducation : BDS / BHMS/ BAMSWorking timing: General Shift / Morning Shift/ Afternoon Shift/Job Location : Dairy Circle, Bannerghatta Road, BangaloreNote : This position is for Working from office only. Please do not apply if you are looking for working from home.Job Types: Full-time, PermanentPay: ₹20,000.00 - ₹25,000.00 per monthWork Location: In person

BDS Doctors for working from Office _ Non clinical Company

Roles and Responsibilities01. Involves Processing of Claims / Preauth/ Audit ( Preauthorization / Reimbursement claims)02. Validating and processing claims / Auditing within TAT and Quality03. With good communication and medical Knowledge04. Complete / process the assigned claims within a dayFinancial : To see to that there is no financial implication for the organization while settlement of claimsRole : Medical OfficerRequired Knowledge /Skill : Good Medical knowledge to evaluate the treatment planEducation : MBBSWorking timing: General Shift / Morning Shift/ Afternoon Shift/ Night ShiftJob Location : Ram Kripa, Himmat Nagar, Gopalpura, JaipurNote : This position is for Working from office only. Please do not apply if you are looking for working from home.Job Types: Full-time, FresherPay: ₹54,000.00 - ₹55,000.00 per monthApplication Question(s):<ul><li>Are you a MBBS Doctor?</li></ul>Work Location: In person

MBBS _ Non Clinical _ Working from Office

Molina Healthcare

<div>
 
 Job Description
 
 
 
 
 Job Summary
 
 
 
 Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care.
 
 
 
 Job Duties
 
 
 
 <ul>
 <li>
 Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing.
 </li>
 <li>
 Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions.
 </li>
 <li>
 Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers.
 </li>
 <li>
 Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues.
 </li>
 <li>
 Identifies and reports quality of care issues.
 </li>
 <li>
 Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience.
 </li>
 <li>
 Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings.
 </li>
 <li>
 Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions.
 </li>
 <li>
 Supplies criteria supporting all recommendations for denial or modification of payment decisions.
 </li>
 <li>
 Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals.
 </li>
 <li>
 Provides training and support to clinical peers.
 </li>
 <li>
 Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols.
 
 
 </li>
 </ul>
 
 Job Qualifications
 
 
 
 
 REQUIRED QUALIFICATIONS:
 
 
 
 <ul>
 <li>
 At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience.
 </li>
 <li>
 Registered Nurse (RN). License must be active and unrestricted in state of practice.
 </li>
 <li>
 Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC).
 </li>
 <li>
 Experience working within applicable state, federal, and third-party regulations.
 </li>
 <li>
 Analytic, problem-solving, and decision-making skills.
 </li>
 <li>
 Organizational and time-management skills.
 </li>
 <li>
 Attention to detail.
 </li>
 <li>
 Critical-thinking and active listening skills.
 </li>
 <li>
 Common look proficiency.
 </li>
 <li>
 Effective verbal and written communication skills.
 </li>
 <li>
 Microsoft Office suite and applicable software program(s) proficiency.
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications.
 </li>
 <li>
 Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics.
 </li>
 <li>
 Billing and coding experience.
 
 
 </li>
 </ul>
 To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
 
 
 Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
 
 
 Pay Range: $29.05 - $67.97 / HOURLY
 
 
 <ul>
 <li>
 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
 </li>
 </ul>
</div>

Medical Review Nurse (RN)

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2356 claims auditor jobs Near Me

Medical Claims Auditor - Fraud waste

Insurance Auditor

Claim Audit Quality Specialist

BDS Doctors for working from Office _ Non clinical Company

MBBS _ Non Clinical _ Working from Office

Medical Review Nurse (RN)

Claim Audit Quality Specialist