Healthcare Claims Auditor

Gainwell Technologies LLC

7d•$35,000 - $50,000•Remote

About The Position

As a COB Claims Auditor, Associate at Gainwell, you will apply strong analytical skills and attention to detail to ensure insurance claims are accurate, compliant, and processed in accordance with policy guidelines and regulatory requirements. By auditing claim files, validating payment accuracy, and identifying discrepancies, you will help safeguard the integrity of the claims process and support positive outcomes for the communities we serve. In this role, you will collaborate closely with management and the claims processing team to ensure compliance with internal procedures and state and federal regulations.

Requirements

Experience reviewing and verifying healthcare insurance claims for accuracy and compliance
Experience reviewing and interpreting EOB/EOP and Remittance Advice
Prior experience conducting claim audits or payment accuracy analysis
Knowledge of state and federal insurance regulations and compliance standards
Strong attention to detail with the ability to analyze complex information
Effective written and verbal communication skills
Ability to work independently in a remote environment while managing priorities and deadlines

Responsibilities

Review and verify insurance claims for accuracy, completeness, and compliance with policy terms and regulatory requirements
Audit claim files and analyze claim payment accuracy, including complex claims
Review and interpret Explanation of Benefits (EOB), Explanation of Payment (EOP), and Remittance Advice documents
Identify inconsistencies, discrepancies, or potential errors and escalate findings to the appropriate teams for resolution
Ensure claim payments align with company procedures, contractual guidelines, and regulatory standards
Collaborate with management and claims processing teams to research and resolve claim issues
Maintain current knowledge of state and federal regulations related to insurance claims and compliance requirements
Prepare audit documentation, reports, and summaries outlining findings and recommendations