Remote Health Insurance Claims Auditor

Introduction: Make an Impact in the Healthcare Ecosystem

Are you passionate about improving healthcare systems while working from the comfort of your home? As a Remote Health Insurance Claims Auditor, you’ll be instrumental in safeguarding the fiscal integrity, ensuring regulatory compliance, and uncovering insights that shape better patient outcomes. Join a team that believes in purposeful work, embraces collaboration, and empowers professionals to take ownership of their future. With the growing demand for health insurance auditing expertise in the remote landscape, this role offers you a chance to take charge and help redefine claims accuracy in modern healthcare.

Key Responsibilities

Claims Audit Duties

• Conduct detailed audits of medical and insurance claims to identify billing discrepancies, coding errors, and policy violations.
• Evaluate claims for compliance with government and commercial insurance guidelines, including HIPAA and CMS standards.

Reporting and Collaboration

• Deliver actionable reports with audit findings, recommending process improvements to mitigate future errors.
• Collaborate with medical coders, claims adjusters, and compliance teams to verify procedural accuracy.

Data Analysis and Documentation

• Use data analytics tools to track trends, anomalies, and potential fraud risks across high-volume claims datasets.
• Maintain meticulous documentation of audit findings and communicate results with stakeholders in a clear, professional manner.

Quality Assurance

• Participate in internal quality assurance initiatives and contribute to company-wide process improvements.

Work Environment

Remote Flexibility

This fully remote opportunity allows you to operate comfortably from your ideal environment—whether that’s a quiet home office or your favorite local workspace.

Team Culture

The team culture thrives on accountability, communication, and mutual respect. You’ll be surrounded by talented, passionate professionals who genuinely care about improving the healthcare system.

Collaboration and Support

Weekly virtual check-ins, structured workflows, and performance transparency ensure that everyone moves forward together, regardless of their location.

Tools and Technology

Platforms and Software

• Claims management platforms such as XactAnalysis, MedReview, or OptumInsight
• HIPAA-compliant document and data-sharing tools
• Audit management software and secure remote access systems

Analytical Tools

• Microsoft Excel and data visualization dashboards for reporting
• ICD-10, CPT, and HCPCS medical coding references and tools

Qualifications

Required Skills and Experience

• Minimum of 3 years of experience in healthcare claims auditing, insurance billing, or medical coding
• Strong understanding of insurance policies, reimbursement methodologies, and healthcare regulations
• Proficiency with ICD-10, CPT, and HCPCS coding systems and associated auditing standards
• Familiarity with CMS, Medicare/Medicaid rules, and other third-party payer protocols
• Ability to interpret EOBs, itemized statements, and complex claim documentation with precision
• Exceptional attention to detail and analytical problem-solving skills
• Strong communication skills for reporting findings to both technical and non-technical teams
• Self-motivated and organized with the ability to meet deadlines in a remote work setup

Preferred Certifications

• Certified Professional Medical Auditor (CPMA)
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
• Certified Fraud Examiner (CFE) or similar credentials are a plus

Compensation and Benefits

Competitive Salary and Benefits

• Annual Salary: $55,805—competitive compensation for your expertise
• 100% remote work setup with flexible working hours

Health and Wellbeing

• Comprehensive health, dental, and vision insurance
• Paid time off, parental leave, and wellness days

Professional Development

• Career advancement opportunities and upskilling support
• Performance-based bonuses and recognition programs
• An inclusive, values-driven culture that celebrates individuality

Role Impact and Purpose

Mission Contribution

Your work will directly impact the financial sustainability of healthcare programs and contribute to the prevention of fraud, cost containment, and improved access to care.

Responsibility in a Changing Landscape

As healthcare systems evolve and expand across digital frontiers, your role as a remote auditor ensures that policies are followed, patients are protected, and payers are held accountable.

Real-World Impact

Your insights could be the difference between a denied claim and someone receiving life-saving treatment on time.

Career Path and Advancement

Growth Opportunities

Auditors in this role often transition into leadership positions within compliance, healthcare analytics, or operational strategy.

Career Trajectory

With continued learning and internal mentorship, you’ll be equipped to grow into roles such as Audit Manager, Compliance Director, or Senior Risk Analyst in the future.

Call to Action

Your Next Big Opportunity Awaits—Apply Now!

Don’t miss your chance to join a company that values integrity, curiosity, and commitment. This is more than just a job—it’s a platform to create a measurable impact in the health insurance sector. If you're ready to drive meaningful change, solve real-world problems, and grow professionally within a future-ready team, we want to hear from you. Apply today and take the next step toward a rewarding remote career.