Healthcare Claims Auditor

Job Description: • Review and verify insurance claims for accuracy, completeness, and compliance with policy terms and regulatory requirements • Audit claim files and analyze claim payment accuracy, including complex claims • Review and interpret Explanation of Benefits (EOB), Explanation of Payment (EOP), and Remittance Advice documents • Identify inconsistencies, discrepancies, or potential errors and escalate findings to the appropriate teams for resolution • Ensure claim payments align with company procedures, contractual guidelines, and regulatory standards • Collaborate with management and claims processing teams to research and resolve claim issues • Maintain current knowledge of state and federal regulations related to insurance claims and compliance requirements • Prepare audit documentation, reports, and summaries outlining findings and recommendations Requirements: • Experience reviewing and verifying healthcare insurance claims for accuracy and compliance • Experience reviewing and interpreting EOB/EOP and Remittance Advice • Prior experience conducting claim audits or payment accuracy analysis • Knowledge of state and federal insurance regulations and compliance standards • Strong attention to detail with the ability to analyze complex information • Effective written and verbal communication skills • Ability to work independently in a remote environment while managing priorities and deadlines Benefits: • generous, flexible vacation policy • 401(k) employer match • comprehensive health benefits • educational assistance • leadership and technical development academies Apply tot his job