Claims Auditor - Claims Auditing

This position is responsible for maintaining managed care health plan delegated auditing functions, including but not limited to, review of pre and post payment of claims, documenting errors assigned, reporting of claims processing errors and providing feedback to ensure compliance with all health plans and regulatory agencies. Regulatory agencies include CMS (Centers for Medicare & Medicaid Services), DMHC (Department of Managed Health Care), and DHCS (Department of Health Care Services). This position secures data integrity and maintains accuracy standards by conducting routine and complex audits to identify exceptions to established claims adjudication requirements for clams processing, payment, and procedural accuracy. This position will report to the Supervisor, Claims Audit.