Health Claims Auditor & Compliance Specialist

Paycom - ATS; Irvine (CA); On-site; USD 60,000 - 85,000; Full time

Job summary

Paycom - ATS in Irvine, CA is seeking a Claims Auditor to perform in-depth audits of health benefit claims for compliance with plan descriptions and regulatory requirements. The role emphasizes accuracy in claims processing, HIPAA compliance, and clear reporting to management.

You will review paper and electronic claims, identify errors, prepare reports, and support training to enhance processing accuracy. Strong CPT/ICD-10 knowledge and contract interpretation are essential.

Qualifications

• BS/BA degree preferred with 1–3 years of medical/dental claims auditing experience.
• Solid understanding of PPACA, HIPAA, COBRA, and ERISA regulations.
• Strong CPT/ICD-10 knowledge and medical terminology.

Responsibilities

• Perform routine and moderately complex audits on health claims for payment integrity.
• Audit claim coding and system configuration; extract and review exception reports.
• Prepare management reports and highlight trends for training and policy updates.
• Provide training support and respond to management inquiries on processing issues.

Skills

Claims auditing

HIPAA knowledge

CPT/ICD-10 proficient

Data analysis

Communication skills

Training/support

Problem solving

Time management

Education

BS/BA degree

Tools

Excel

Word/Docs

Audit software

Job description

Paycom - ATS in Irvine, CA is seeking a Claims Auditor to perform in-depth audits of health benefit claims for compliance with plan descriptions and regulatory requirements. The role emphasizes accuracy in claims processing, HIPAA compliance, and clear reporting to management.

You will review paper and electronic claims, identify errors, prepare reports, and support training to enhance processing accuracy. Strong CPT/ICD-10 knowledge and contract interpretation are essential.