Hospital Claims Auditor - 243613


We're Hiring: Remote Hospital Claims Auditor (Anywhere in the U.S.)

Are you an experienced Claims professional with a strong background in hospital or risk claims? Ready to take the next step in your healthcare career while working 100% remotely? We’re looking for a Hospital Claims Auditor to join a mission-driven team committed to improving healthcare outcomes and fostering a culture of integrity, growth, and collaboration.


What You'll Do

As a Hospital Claims Auditor, you’ll be responsible for ensuring the accuracy, compliance, and overall quality of claims processes in alignment with industry regulations and client contracts. You'll serve as a subject matter expert, trainer, and collaborator across departments to drive operational excellence.


Key Responsibilities:

  • Audit processed claims for accuracy and compliance using system-generated reports
  • Train and support Claims Examiners; maintain training documentation
  • Investigate contract, system, and processing issues; identify trends and recommend resolutions
  • Collaborate with cross-functional teams to improve claims processes
  • Contribute to the development and documentation of departmental policies
  • Provide backup coverage for auditors/trainers as needed
  • Participate in internal meetings and support special projects as assigned


What We’re Looking For

Must-Have Qualifications:

  • 3+ years of experience in managed care claims adjudication (HMO/MSO)
  • 1+ year of direct experience with hospital or risk claims (facility claims)
  • Strong understanding of shared risk DOFRs, provider contracts, and LOAs
  • Experience with Medi-Cal, Medicare, or Commercial lines of business (at least one required)
  • Ability to read and apply authorizations, contracts, and reimbursement methodologies


Nice-to-Have:

  • Medi-Cal experience
  • Quick learner with high attention to detail and policy compliance
  • Adaptable, proactive, and collaborative work style


Position Details

  • Location: Remote (open to candidates in any U.S. state)
  • Schedule: Monday–Friday | Choose your own start time between 6AM–9AM PST
  • Compensation: $23–$27/hour
  • Benefits: Competitive benefits package + generous PTO + career growth opportunities


Why Join Us?

  • Fully Remote: Work from anywhere in the U.S.
  • Career Growth: We promote from within—leaders have worked their way up
  • Culture & Morale: Team celebrations, contests, and a collaborative spirit
  • Stability & Impact: Be part of a growing organization making a real difference in healthcare


Apply Now!

If you’re a detail-oriented, experienced Claims professional ready to join a company that values growth, integrity, and teamwork—we want to hear from you! Apply today and help us continue to raise the standard in healthcare claims quality.