Remote Healthcare Claims Quality Auditor

HealthCare Resolution Services; Columbia (MD); On-site; USD 60,000 - 70,000; Full time

Job summary

A health care auditing firm based in Maryland is seeking a Claims Auditor to conduct audits of medical and dental claims. The role requires a Bachelor's degree in accounting, finance, or a related field, along with at least three years of experience in a similar position. Ideal candidates will have strong analytical skills and the ability to communicate complex information clearly. This position includes reviewing claims for compliance and validating eligibility and network participation.

Qualifications

• At least three years of experience as a claims auditor or similar role in the health care industry.

Responsibilities

• Conduct audits of medical and dental claims to ensure proper processing.
• Validate claimant eligibility and provider network participation.
• Review claims for compliance with internal policies and regulations.

Skills

Strong analytical and problem-solving skills

Excellent attention to detail

Ability to communicate complex information effectively and clearly

Good understanding of insurance policies and regulations

Proficiency in using computer software such as Microsoft Office Suite

Education

Bachelor's degree in accounting, finance, or a related field

Job description

A health care auditing firm based in Maryland is seeking a Claims Auditor to conduct audits of medical and dental claims. The role requires a Bachelor's degree in accounting, finance, or a related field, along with at least three years of experience in a similar position. Ideal candidates will have strong analytical skills and the ability to communicate complex information clearly. This position includes reviewing claims for compliance and validating eligibility and network participation.