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.