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Medical Claims Auditor

https://www.roberthalf.com Logo

Robert Half

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Location:
United States , Emeryville

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Category:
Insurance

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

We are looking for an experienced Medical Claims Auditor to join our team in Emeryville, California. In this long-term contract position, you will play a pivotal role in ensuring the accuracy and compliance of medical claims while also serving as a trainer to enhance team knowledge and performance. If you have a strong background in medical coding, auditing, and training, this opportunity is ideal for you.

Job Responsibility:

  • Conduct detailed audits of paid, pending, and denied medical claims to ensure proper coding, adherence to benefit rules, and compliance with state and federal regulations, including the California Knox-Keene Act and Medi-Cal
  • Design and deliver comprehensive training programs for Claims Examiners, focusing on workflows, updated policies, and emerging technologies
  • Investigate complex claim issues, including provider disputes and appeals, and identify trends to propose effective corrective actions
  • Compile and maintain detailed statistical and quality reports, presenting audit findings and staff performance metrics to management
  • Stay informed about federal and state billing laws, including Medicare guidelines, to ensure compliance during health plan audits
  • Collaborate with team members to resolve discrepancies and implement efficient claims processing practices
  • Assist in the development of new audit procedures and quality control measures to continuously improve operations
  • Provide subject matter expertise in medical coding standards, including ICD-10 and CPT codes, to support organizational goals
  • Contribute to special projects and initiatives as needed to enhance claims auditing and training functions

Requirements:

  • A minimum of 7 years of experience in medical coding, auditing, and claims processing
  • Strong knowledge of ICD-10 and CPT codes, along with certified coding credentials
  • Expertise in auditing insurance claims and ensuring compliance with state and federal regulations
  • Proven ability to conduct training sessions and develop educational resources for team members
  • Familiarity with Medi-Cal and the California Knox-Keene Act
  • Exceptional analytical skills to identify trends and resolve complex claim issues
  • Proficiency in preparing statistical reports and presenting findings to stakeholders
  • Strong communication skills and the ability to collaborate effectively with diverse teams
What we offer:
  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in our company 401(k) plan

Additional Information:

Job Posted:
April 01, 2026

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