Healthcare Claims Auditor
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. 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 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 Benefits • flexible vacation policy • 401(k) employer match • comprehensive health benefits • educational assistance • leadership and technical development academies Apply tot his job