Claims Audit Specialist

WelbeHealth

Claims Audit Specialist at WelbeHealth ensuring the timely and accurate payment or denial of healthcare claims. Collaborating with leadership to identify trends and improve processes.

Posted 5/2/2026full-timeRemote • California • 🇺🇸 United StatesMid-LevelSenior💰 $74,612 - $98,488 per yearWebsite

About the role

Key responsibilities & impact

Review processed claims for pre and post payment accuracy while maintaining acceptable levels of aged claims inventory
Ensure claim payment accuracy by verifying various aspects of the claim form, including but not limited to participant eligibility, system configuration, payment accuracy or denial appropriateness, provider records, remark codes, pre-authorization requirements, timely filing limitations, claim history, and W9 receipt
Maintain detailed documentation of audit findings, including decision methodology, system configuration or manual processing errors, and monetary discrepancies
Regularly provide feedback to the Oversight & Monitoring Manager on claims processing errors, as well as identify quality improvement opportunities and initiate configuration change requests when applicable
Accurately process and release high dollar/stop loss claims exceeding $10k
Participate in annual claims audits to cure any deficiencies in claims system, human error, or possible fraud, waste, and abuse in order to maintain contractual and regulatory compliance
Act as a back up to the Claims team as needed

Requirements

What you’ll need

Bachelor’s degree in relevant field; professional experience may be substituted
Minimum of five (5) years of experience processing, researching, adjusting, and auditing Medicare and Medicaid professional, institutional, and dental health insurance claims
Experience processing and auditing disputes, appeals and recoveries
Proficient experience in Microsoft Excel
Working knowledge of the health plan insurance industry, CPT/HCPCS procedure codes, ICD-10 codes, and relevant federal and state regulations
Experience working with CMS and Medi-Cal healthcare claims
Strong organizational, analytical, communication, and time management skills

Benefits

Comp & perks

Medical insurance coverage (Medical, Dental, Vision)
Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
401K savings + match
Comprehensive compensation package including base pay and bonus
And additional benefits!

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

claims processingclaims auditingMedicare claimsMedicaid claimsCPT codesHCPCS codesICD-10 codesdata analysisdocumentationerror identification

Soft Skills

organizational skillsanalytical skillscommunication skillstime management skillsfeedback provisionquality improvementproblem-solving

Certifications

Bachelor’s degree