Provider Auditor Lead – Payment Integrity, Clinical Audit

Elevance Health

Provider Auditor Lead managing the audit program for Elevance Health. Leading day-to-day activities of the audit team with a focus on compliance and fraud investigation.

Posted 5/9/2026full-timeNorfolk • Ohio, Texas, Virginia • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

Leads day-to-day activities of the audit team
Creates and manages workflow assignments
Establishes priorities and serves as a resource for training lower-leveled audit associates
Operates as the SME (subject matter expert) for a specific line of business
Documents workflow processes
Collaborates across business lines through the facilitation of meetings
Manages vendor relationships with contracted vendors
Investigates potential fraud and over-utilization by performing complex medical reviews
Conducts provider meetings to discuss audit findings and appeals
Researches claims payment methodologies and fee schedule pricing
Adjusts and re-prices claims per audit findings
Assists in resolving contractual issues with providers
Prepares and analyzes various reports

Requirements

What you’ll need

Requires a BA/BS degree
Minimum of 5 years of experience in a related field, including provider audit reimbursement, and analytics
Project management and leadership experience
Minimum of 2 years of claims review experience highly desired
Experience related to medical coding, including coding certification, nursing licensure, and/or a clinical background, is strongly preferred

Benefits

Comp & perks

Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short and long term disability benefits
401(k) + match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

provider audit reimbursementanalyticsclaims reviewmedical codingworkflow managementreport analysisfraud investigationfee schedule pricingcontractual issue resolutioncomplex medical reviews

Soft Skills

leadershipproject managementcollaborationtrainingcommunicationprioritizationresource managementfacilitationproblem-solvinginterpersonal skills

Certifications

coding certificationnursing licensure