Senior Claims Quality Auditor – Regulatory Compliance & Improvement

LSMA Management, Inc.; San Bernardino (CA); On-site; USD 70,000 - 90,000; Full time

Job summary

A healthcare management organization is seeking a Quality Control Auditor – Claims Management in California. This role is responsible for auditing claims processing activities to ensure compliance and accuracy. With over five years of experience in managed care claims auditing required, candidates should possess strong analytical skills and familiarity with coding standards. The position demands independence and attention to detail, offering an opportunity to contribute to operational improvements within a regulated environment.

Qualifications

• Minimum 5 years of managed care claims auditing or equivalent experience.
• Experience as a Claims Examiner or Claims Adjuster is preferred.
• Knowledgeable about relevant coding standards and reimbursement methodologies.

Responsibilities

• Perform detailed audits of claims processing activities.
• Evaluate claims adjudication performed by Claims Examiners.
• Identify errors and analyze trends to improve claims accuracy.

Skills

Managed care claims processing

Audit methodologies

Analytical skills

Attention to detail

Communication skills

Education

High School Diploma or equivalent

Associate’s or Bachelor’s degree

Tools

EZ Cap

Microsoft Office

Job description

A healthcare management organization is seeking a Quality Control Auditor – Claims Management in California. This role is responsible for auditing claims processing activities to ensure compliance and accuracy. With over five years of experience in managed care claims auditing required, candidates should possess strong analytical skills and familiarity with coding standards. The position demands independence and attention to detail, offering an opportunity to contribute to operational improvements within a regulated environment.