Claims Auditor: Drive Payment Integrity & Savings

Redirect Health Inc; Phoenix (AZ); On-site; USD 50,000 - 55,000; Full time

Benefits offered by this job

Free healthcare

Paid time off

Sick time

401(k) access

Job summary

Redirect Health Inc. in Phoenix, AZ is seeking a Dedicated Claims Auditor to oversee and ensure comprehensive medical and pharmacy claims auditing practices for our members. You will identify overpayments, analyze trends, and support recovery efforts to sustain our 0% error goal.

The role emphasizes accuracy, process improvements, and collaboration with the Claims Management team. A healthcare background with auditing experience is preferred, and the company offers a mission-driven environment

Qualifications

• 2+ years in a dedicated claims/auditing role, healthcare or customer service preferred.
• Strong system and rules analysis, problem-solving, and decision-making abilities.
• Excellent communication and interpersonal skills.

Responsibilities

• Perform detailed audits of medical and pharmacy claims to verify payment accuracy.
• Validate claims against internal reimbursement methodologies, contracts, fee schedules, and plan documents.
• Review high-dollar, complex, and outlier claims for billing accuracy.
• Identify claim overpayments, underpayments, and recovery opportunities.
• Analyze reimbursement trends and claim payment anomalies.
• Support recovery efforts through reprocessing recommendations and financial impact analyses.
• Recommend process improvements to reduce claim leakage and optimize plan spend.

Skills

System analysis

Rules analysis

Problem-solving

Decision making

Communication

Tools

Audit guidelines

Job description

Redirect Health Inc. in Phoenix, AZ is seeking a Dedicated Claims Auditor to oversee and ensure comprehensive medical and pharmacy claims auditing practices for our members. You will identify overpayments, analyze trends, and support recovery efforts to sustain our 0% error goal.

The role emphasizes accuracy, process improvements, and collaboration with the Claims Management team. A healthcare background with auditing experience is preferred, and the company offers a mission-driven environment