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Elevance Health · 3 days ago

Claims Auditor I, II & Senior

Grand Prairie, TX

Full-time

Hybrid

Entry, Mid, Senior Level

$21.41/hr - $38.88/hr

3+ years exp

Elevance Health is a health company dedicated to improving lives and communities. They are seeking Claims Auditors at various levels to perform audits of high dollar claims, ensure claim payment accuracy, and serve as subject matter experts in the auditing process.

Health CareHealth InsurancePersonal HealthWellness

H1B Sponsor Likely

Responsibilities

Performs audits of high dollar claims

Ensures claim payment accuracy by verifying various aspects of the claim including eligibility, pre-authorization, and medical necessity

Contacts others to obtain any necessary information

Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis

Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to coding or system issues, where applicable

Refers overpayment opportunities to Recovery Team

Claims Auditor II - all the above, plus: Independently interprets Medical Policy and Clinical Guidelines

Claims Auditor Senior - all the above, plus : Service as a subject matter expert for Policy and Clinical Guidelines. Associates at this level serve as a mentor and resource to other audit staff. Must possess strong research and problem solving skills

Qualification

Claims processing experienceQuality audit experienceMedical Policy interpretationStop loss claims experienceInsurance industry knowledgeMedical terminology knowledgeResearch skillsProblem solving skills

Required

Claims Auditor I: Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide an equivalent background

Claims Auditor II: Requires a HS diploma or GED and a minimum of 5 years of claims processing experience including a minimum of 1 year related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background

Claims Auditor Senior: Requires a HS diploma or GED and a minimum of 4 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background

Preferred

Stop loss claims experience highly preferred

Working knowledge of insurance industry and medical terminology; working knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines strongly preferred

Ability to acquire and perform progressively more complex skills and tasks in a production environment strongly preferred

Strong research and problem solving skills preferred

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Short and long term disability benefits

401(k) +match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Company

Elevance Health

Glassdoor3.6

Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.

Founded in 1944

Indianapolis, Indiana, USA

10001+ employees

https://www.elevancehealth.com

H1B Sponsorship

Elevance Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

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2025 (488)

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2023 (660)

2022 (222)