Claims Auditor – Quality & Process Improvement

Centivo Corporation; Buffalo (NY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Centivo is seeking a Claims Auditor to conduct pre- and post-payment audits across employer groups and product lines, ensuring accuracy and adherence to plan descriptions. The role supports the Claims Quality Review program and ensures timely, accurate audit reporting.

The candidate will collaborate with QA leads and managers, identify trends, mentor adjustors, and help improve processing guidelines. Hybrid/remote options may apply.

Qualifications

• High School diploma or GED required.
• Associate or Bachelor's degree preferred.
• Minimum of three years of experience as a claim adjustor and/or auditor in self-funded plans or TPA environment.
• Proficient in MS Word, Excel, Outlook and PowerPoint.

Responsibilities

• Perform auditing of claims for internal and external constituents to ensure accuracy and compliance.
• Complete reporting of audits with methodology for procedural and monetary errors.
• Communicate corrections to Claims Adjustors and verify accuracy of adjustments.
• Identify and elevate trends based on quality reviews.
• Collaborate with QA Lead, Supervisors, Managers on issues requiring action.
• Investigate issues to improve standard processing guidelines and participate in related projects.
• Assist with training, policy creation, and mentoring of Claims Adjustors.

Skills

Analytical skills

Communication skills

Detail-oriented

Process understanding

Education

High School diploma or GED

Associate or Bachelor's degree preferred

Tools

El Dorado-Javelina

HRP Health Rules Payer

MS Word

MS Excel

PowerPoint

Outlook

Job description

Centivo is seeking a Claims Auditor to conduct pre- and post-payment audits across employer groups and product lines, ensuring accuracy and adherence to plan descriptions. The role supports the Claims Quality Review program and ensures timely, accurate audit reporting.

The candidate will collaborate with QA leads and managers, identify trends, mentor adjustors, and help improve processing guidelines. Hybrid/remote options may apply.