Dedicated Claims Auditor

Redirect Health•Phoenix, AZ

9d•$50,000 - $55,000•Onsite

About The Position

At Redirect Health, we’re on a mission to make healthcare accessible and affordable for everyone. We are currently accepting applications for a Dedicated Claims Auditor. Are you a healthcare professional who thrives in a fast-paced, adaptable environment and is passionate about delivering exceptional service? We’re looking for a Dedicated Claims Auditor to oversee and ensure comprehensive medical and pharmacy claims auditing practices for our members. This is an opportunity to make a direct impact, examine and improve workflows, and support the Claims Management team in sustaining our vision of 0% Error Rates —all while helping people access the care they need.

Requirements

2+ years in a dedicated claims and/or auditing role, preferably in healthcare or customer service
Strong system and rules analysis, problem-solving, and decision-making abilities.
Excellent communication and interpersonal skills.

Responsibilities

Perform detailed audits of medical and pharmacy claims to verify payment accuracy, coding appropriateness, and adherence to plan provisions.
Validate claims against internal reimbursement methodologies, contracts, fee schedules, and plan documents.
Review high-dollar, complex, and outlier claims for billing accuracy and reimbursement integrity.
Identify claim overpayments, underpayments, and recovery opportunities.
Analyze reimbursement trends and claim payment anomalies.
Support recovery efforts through reprocessing recommendations and financial impact analyses.
Recommend process improvements to reduce claim leakage and optimize plan spend.