Healthcare Claims Auditor
Gainwell Technologies
full-time
Posted on:
Location Type: Remote
Location: Texas • United States
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Salary
💰 $35,000 - $50,000 per year
About the role
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
insurance claims reviewclaims auditingpayment accuracy analysisEOB interpretationEOP interpretationRemittance Advice analysisregulatory compliancedocumentation preparationreportingdata analysis
Soft skills
attention to detaileffective communicationindependent worktime managementproblem-solvingcollaborationanalytical thinkingprioritizationadaptabilitycritical thinking