Remote Claims Auditor — Medicare/Medicaid Compliance

SCAN Health Plan; Long Beach (CA); Remote; USD 35,000 - 51,000; Full time

Benefits offered by this job

Annual bonus program

Wellness program

PTO

eleven holidays + floating birthday

401(k) with company match

Tuition reimbursement

Job summary

SCAN Health Plan is seeking a Claims Auditor to perform pre-pay and post-pay audits ensuring accurate payments and compliant denials. You will work with the Claims Department to review processing errors, document cases, and support process improvements across the organization.

The role requires 3+ years of complex claims experience, CMS knowledge, and familiarity with IKA/QNXT systems, with remote-possible work options.

Qualifications

• Associate degree or equivalent experience preferred.
• 3+ years of complex claims processing and/or auditing in health plan or managed care.
• Proficient in processing/auditing Medicare and Medicaid claims.
• Strong knowledge of CMS requirements for claims processing.
• Experience with DOFR and COB.
• Experience with Institutional and Professional claim payments.
• Knowledge of CPT4, ICD9, ICD10, DRG and HCPCS codes.
• Health insurance training or equivalent knowledge.

Responsibilities

• Perform pre-pay and post-pay audits to ensure accurate claims payments and denials.
• Ensure regulatory compliance and quality by applying claims processing standards.
• Use SCAN’s workflow system to track and resolve audits and cases.
• Document case status and resolutions with detail for clarity.
• Collaborate with Claims Department to correct processing errors before final payment.
• Follow policies to maintain compliant operations and propose workflow improvements.

Skills

CMS requirements

Medicare/Medicaid claims

Claims auditing

DOFR & COB

Institutional & Professional claims

CPT4 ICD9 ICD10

HCPCS

Health insurance training

Benefit structures

Education

Associate degree or equivalent

Tools

IKA

QNXT

Job description

SCAN Health Plan is seeking a Claims Auditor to perform pre-pay and post-pay audits ensuring accurate payments and compliant denials. You will work with the Claims Department to review processing errors, document cases, and support process improvements across the organization.

The role requires 3+ years of complex claims experience, CMS knowledge, and familiarity with IKA/QNXT systems, with remote-possible work options.