Remote Senior Claims Auditor

Covet Health Inc.; United States; Remote; USD 39,000 - 45,000; Full time

Job summary

Covet Health Inc. is seeking experienced claims professionals for a remote, full-time role. You will handle day-to-day processing and adjudication of medical claims, review documentation, and verify coverage according to plan rules.

The position requires 4+ years in a healthcare payer claims environment, strong CPT/HCPCS/ICD-10 knowledge, and excellent communication skills. You will coordinate with claims managers and third-party TPAs to ensure accuracy and compliance.

Qualifications

• 4+ years experience in TPA claims examiner/adjudication.
• Experience with CPT, HCPCS, ICD-10 coding.
• Strong written and verbal communication skills, conflict handling.
• Knowledge of COBRA, HIPAA, and coordination of benefits.
• Ability to analyze and make sound judgments.

Responsibilities

• Process claims daily based on CPT, ICD-10, POS codes and provider types.
• Perform claims processing and adjudication.
• Conduct claims research including medical records and authorizations.
• Verify medical necessity and coverage per policy guidelines.
• Use systems to track complaints and resolutions.
• Collaborate with finance and compliance to ensure plan integrity.

Skills

Claims processing

Adjudication

UB-04 knowledge

CMS-1500 knowledge

CPT coding

HCPCS coding

HIPAA COBRA knowledge

Communication skills

Job description

Covet Health Inc. is seeking experienced claims professionals for a remote, full-time role. You will handle day-to-day processing and adjudication of medical claims, review documentation, and verify coverage according to plan rules.

The position requires 4+ years in a healthcare payer claims environment, strong CPT/HCPCS/ICD-10 knowledge, and excellent communication skills. You will coordinate with claims managers and third-party TPAs to ensure accuracy and compliance.