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Claims Auditor/Trainer

https://www.roberthalf.com Logo

Robert Half

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Location:
United States , Oakland

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Category:
Insurance

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Contract Type:
Not provided

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Salary:

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Job Description:

Unlock Your Next Career Move: Claims Auditor/Trainer Are you meticulous, compliance-driven, and passionate about streamlining healthcare operations? Robert Half is recruiting for a Claims Auditor/Trainer to ensure claims are processed accurately, meet legal standards, and enhance staff knowledge of benefit requirements and regulations.

Job Responsibility:

  • Conduct audits of processed claims (paid, pending, denied) to verify accuracy in medical coding (ICD-10, CPT, HCPCS), benefit application, and compliance with California's Knox-Keene Act and Medi-Cal regulations
  • Develop and deliver training for Claims Examiners, including creation of educational materials on workflows, policy updates, and new technologies
  • Investigate complex claim issues, provider disputes, and appeals
  • identify root causes for systemic issues and recommend corrective actions
  • Track and report statistical data on MSO quality and production
  • Prepare regular reports for management
  • Maintain current knowledge of state and federal billing laws (CMS/Medicare) to ensure compliance and readiness for audits

Requirements:

  • High school diploma, GED or equivalent
  • Four or more years of medical claims payment experience in an HMO environment
  • Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS
  • Understanding of Medicare Guidelines and COB
  • Knowledge of medical terminology
  • Experience in benefit determination and claims adjudication
  • Understanding of detail oriented and facility reimbursement methodologies
  • Strong organizational skills
  • Computer proficiency with Microsoft Office
  • Knowledge of claims adjudication systems (Easy Cap a plus)
  • Flexibility and adaptability
What we offer:
  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in our company 401(k) plan
  • free online training

Additional Information:

Job Posted:
March 13, 2026

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