Healthcare Claims Auditor jobs in United States
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Gainwell Technologies · 21 hours ago

Healthcare Claims Auditor

Gainwell Technologies is a company that values contributions and offers opportunities for career growth. As a COB Claims Auditor, Associate, you will ensure the accuracy and compliance of insurance claims, collaborating with management and the claims processing team to uphold regulatory standards.

Health CareInformation Technology
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H1B Sponsor Likelynote

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

Qualification

Healthcare claims auditingEOB/EOP interpretationInsurance regulations knowledgeAnalytical skillsAttention to detailWritten communicationVerbal communicationIndependent work

Required

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

Generous, flexible vacation policy
A 401(k) employer match
Comprehensive health benefits
Educational assistance
Variety of leadership and technical development academies

Company

Gainwell Technologies

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Gainwell Technologies is a provider of Information Technology & Services. It is a sub-organization of Veritas Capital.

H1B Sponsorship

Gainwell Technologies 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)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (90)
2024 (78)
2023 (56)
2022 (96)
2021 (33)

Funding

Current Stage
Late Stage
Total Funding
$1M
2023-06-06Grant· $1M

Leadership Team

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Paul N. Saleh
President and Chief Executive Officer
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Gary Call
Chief Medical Officer
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Company data provided by crunchbase