Remote Claims Auditor: Quality & Compliance

Dormont Manufacturing Co; Buffalo (NY); Hybrid; USD 52,000 - 60,000; Full time

Job summary

Centivo is seeking a Claims Auditor who will conduct pre-payment, post-payment, and claims adjudication audits across multiple employer groups and product lines, including complex, high-dollar claims.

This role supports the Claims Quality Review program by helping establish processing standards, responding to quality findings, assisting with performance improvement plans, and providing data to support SLAs.

Qualifications

• Three years of experience as a claims examiner and/or auditor.
• Experience with self-funded health care plans.
• Proficient in MS Word, Excel, Outlook, and PowerPoint.

Responsibilities

• Audit claims for processing, payment, and financial accuracy per standards.
• Report audit results and trends for QA and SLAs.
• Communicate corrections to examiners for pre-pay audits.
• Identify trends and collaborate on corrective actions.
• Assist with policy creation, training, and mentoring.

Skills

Analytical skills

Organizational skills

Interpersonal skills

Attention to detail

Education

High School diploma or GED

Associate or bachelor’s degree preferred

Tools

MS Word

Excel

Outlook

PowerPoint

Job description

Centivo is seeking a Claims Auditor who will conduct pre-payment, post-payment, and claims adjudication audits across multiple employer groups and product lines, including complex, high-dollar claims.

This role supports the Claims Quality Review program by helping establish processing standards, responding to quality findings, assisting with performance improvement plans, and providing data to support SLAs.