Senior Auditor, Claims Operations

AltaMed • Montebello, CA

45d • $31 - $39

About The Position

The Senior Auditor, Claims Operations (AHN) is responsible for overseeing the daily review and audit of claims adjudicated by both the claims processing system and Claims Examiners. This role plays a key part in ensuring the accuracy, completeness, and compliance of all claims, while identifying discrepancies such as overpayments and underpayments. The Senior Auditor will work closely with cross-functional teams, including the Claims Recovery Unit, to resolve discrepancies, recoup overpayments, and address underpayments. Additionally, this role involves collaborating with the Health Plan Audits team, reviewing audit findings, and providing actionable insights for continuous improvement in claims processing.

Requirements

• High school diploma, GED, or equivalent required.
• Minimum of 5 years of experience with claims adjudication, claims auditing, claims processing, and dispute resolution within the managed care industry required.
• Must be knowledgeable of Medi-Cal regulations and Managed Care concepts.
• Proficient in claims management systems and auditing tools.
• Deep understanding of healthcare claims adjudication processes, including coding, billing, and reimbursement methodologies.
• Familiarity with health plan audit requirements and regulatory compliance standards.

Benefits

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees