Auditor (Claims)

Paycom - ATS; United States; Remote; USD 50,000 - 80,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Short-Term Disability

401K with company match

Long Term Disability & Life/AD&D

Paid Time Off

Job summary

Southwest Service Administrators is seeking a Claims Auditor to perform audits on medical and dental claims and prepare concise management reports. The role supports the team manager by maintaining documentation and ensuring accuracy across product lines.

The ideal candidate has 3 years of claims analysis experience, strong medical knowledge, and excellent attention to detail. This position emphasizes independent work, collaborative teamwork, and participation in ongoing training.

Qualifications

• High School Diploma or GED required.
• Three (3) years recent experience analyzing medical claims.
• Proficient in medical terminology, CPT/ICD codes, and related claim forms.
• Strong attention to detail with accurate data interpretation.
• Good written and verbal communication skills.

Responsibilities

• Audit medical and/or dental claim activities and prepare reports for management.
• Research processing issues to determine origin and resolution.
• Maintain understanding of plan designs, policies, and compliance regulations.
• Assist in testing system functionality during upgrades and implementations.
• Collaborate with team members and participate in meetings and trainings.

Skills

Medical terminology

CPT Codes

ICD 9/10

Attention to detail

Written communication

Time management

Independent work

Education

High School Diploma/GED

Tools

MS Excel

MS Word

Job description

The Claims Auditor is responsible for all audit activities for medical and/or dental claims while supporting the team manager to create, maintain and provide statistical audit reports and documentation.ResponsibilitiesAuditing & ReportingGain and maintain the understanding of the plan designs and effectively apply that knowledge.Maintain a comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits and turnaround times across all product linesResearch claim processing issues to determine the origin and appropriate resolutionPrepare reports for management summarizing observations and recommendationsAssist in testing system functionality during upgrades and implementationsTeamworkWork cooperatively with other team membersActively participate in team meetings and training activities.Perform additional responsibilities and projects as periodically assigned.Education/Certification:High School Diploma/GEDThree (3) years recent experience analyzing medical claimsSkills/Abilities:Ability to maintain production and quality standards.Extensive knowledge of medical terminology, CPT Codes, ICD 9/10 and medical claim forms.Ability to read, analyze and assess medical documentation and draw valid conclusions.Minimum 40 WPM and 3,000 KPH proficiencySolid knowledge of MS Excel & MS WordProfessional, client-focused approach to colleagues and assignments.Strong oral and written communication skills with exceptional attention to details.Ability to seek out experiences that may change perspective or provide an opportunity to learn new things.Strong dedication to follow-through on all tasks and assignments.Ability to organize, set priorities, work independently and complete multiple projects within established deadlines.Ability to sit for long periods of time operating a computer keyboard.Employee Benefits ProgramCOMPANY PROVIDES:MEDICAL, DENTAL, VISIONSHORT-TERM DISABILITYFull coverage benefits for a low weekly premium of $5 (Employee Only), $15 (for Child(ren) and $20 per week for full family or Employee/Spouse.COMPANY PAID supplemental dental coverage of $1,000 per year for Employee.COMPANY PAID LONG TERM Disability & Life/AD&D coverage.401K Plan including company match up to 5%.COMPANY PAID additional pension plan entirely funded by the company.EXCEPTIONAL TIME OFF package including Paid Personal Leave (PPL) and Vacation with annual BUY BACK options!!!!Annual, automatic pay increases.Southwest Service Administrators provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, or any other considerations made unlawful by applicable state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence compensation and training. Southwest Service Administrators expressly prohibits any form of workplace harassment based on race, color, religion, sex, national origin, pregnancy, military and veteran status, age physical and mental disability, or genetic characteristics.