Remote Claims Audit Lead - Medical Coding & Quality

PacificSource; Bend (OR); Hybrid; USD 65,000 - 111,000; Full time

Benefits offered by this job

Flexible telecommute policy

Medical insurance

401(k) plan

Paid time off

Job summary

PacificSource in Bend, Oregon is seeking a Claim Audit Manager to lead the Claims Audit team and ensure production and quality standards across medical, dental, vision, and self-funded lines.

You will hire, train, coach, and evaluate staff, investigate adjudication issues, and collaborate with Compliance, Grievance and Appeals to drive accurate claim outcomes. The role emphasizes process improvement and strong data reporting for decision making.

Qualifications

• Minimum 4 years of complex claims management experience.
• At least 1 year of supervisory experience required.
• Experience in self-funded claims administration preferred.
• Strong leadership and coaching abilities.

Responsibilities

• Provide supervision, coaching, training, and leadership to assigned staff.
• Ensure claims processing meets department and company standards for production and quality.
• Oversee the Fraud, Waste, and Abuse claim review process.
• Collaborate with Grievance and Appeals to determine appropriate claims outcomes.
• Investigate and settle claims issues as needed.

Skills

Leadership

Claims auditing

Team supervision

Data analysis

Education

High School diploma or equivalent

Job description

PacificSource in Bend, Oregon is seeking a Claim Audit Manager to lead the Claims Audit team and ensure production and quality standards across medical, dental, vision, and self-funded lines.

You will hire, train, coach, and evaluate staff, investigate adjudication issues, and collaborate with Compliance, Grievance and Appeals to drive accurate claim outcomes. The role emphasizes process improvement and strong data reporting for decision making.