Senior Claims Auditor Lead - Hybrid

Elevance Health; Atlanta (GA); Hybrid; USD 100,000 - 150,000; Full time

Job summary

Elevance Health is seeking a Claims Auditor Lead to oversee high-dollar medical and pharmacy claim audits in a hybrid office setting in Atlanta. The role requires expertise in pre- and post-payment audits, policy interpretation, and mentoring staff to follow procedures and achieve quality goals.

Responsibilities include training, conducting audits, maintaining policy manuals, coordinating with cross-functional teams, and presenting findings to leadership.

Qualifications

• Performs quality audits and training to ensure adherence to guidelines.
• Experience in healthcare or insurance quality audits and processes.
• Ability to coach and mentor staff to follow procedures.

Responsibilities

• Train new hires and cross-train the team.
• Audit high-dollar claims and complex cases end-to-end.
• Review and maintain records of quality and productivity for the team.
• Coach, mentor and develop associates to ensure proper use of processes and tools.
• Create and maintain department policy and audit manuals.

Skills

Quality audits

Team training

Healthcare/insurance experience

Education

HS diploma or GED

Tools

Microsoft Office Suite

CI&W

WGS

Job description

Elevance Health is seeking a Claims Auditor Lead to oversee high-dollar medical and pharmacy claim audits in a hybrid office setting in Atlanta. The role requires expertise in pre- and post-payment audits, policy interpretation, and mentoring staff to follow procedures and achieve quality goals.

Responsibilities include training, conducting audits, maintaining policy manuals, coordinating with cross-functional teams, and presenting findings to leadership.