Claims Auditor - Claims Auditing

Providence • Anaheim, CA

1d • Onsite

About The Position

This position is responsible for maintaining managed care health plan delegated auditing functions, including but not limited to, review of pre and post payment of claims, documenting errors assigned, reporting of claims processing errors and providing feedback to ensure compliance with all health plans and regulatory agencies. Regulatory agencies include CMS (Centers for Medicare & Medicaid Services), DMHC (Department of Managed Health Care), and DHCS (Department of Health Care Services). This position secures data integrity and maintains accuracy standards by conducting routine and complex audits to identify exceptions to established claims adjudication requirements for clams processing, payment, and procedural accuracy. This position will report to the Supervisor, Claims Audit. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Requirements

• 3 years of claims processing experience in a managed care environment

Nice To Haves

• 1 year of claims audit experience
• Experience processing Medicare, Medi-Cal, or One Care Connect claims

Responsibilities

• Review of pre and post payment of claims
• Documenting errors assigned
• Reporting of claims processing errors
• Providing feedback to ensure compliance with all health plans and regulatory agencies
• Conducting routine and complex audits to identify exceptions to established claims adjudication requirements for claims processing, payment, and procedural accuracy

Benefits

• Best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed