TPA Medical Claims Auditor

Job Description

Insight Global is seeking a Medical Claims Auditor to support a healthcare client. This individual will conduct daily quality assurance audits of processed medical claims to verify financial accuracy, proper coding, and compliance with applicable state and federal regulations. The Medical Claims Auditor will identify processing issues, provide audit feedback, support training initiatives, and help maintain consistent quality and production standards.

Additional responsibilities include:

Learn and understand established claims processes and workflows. Conduct daily audits of processed medical claims. Support additional program audits as assigned by department leadership. Assist with the development and implementation of auditing and monitoring processes. Review claims for accuracy, quality, and compliance. Provide audit feedback and identify potential training needs. Investigate and research claims-related issues. Assist with claims processing and other department responsibilities as needed. Serve as a subject matter expert for claims-related questions. Prepare statistics related to individual and departmental performance.

Skills and Requirements

At least five years of experience as a claims examiner or claims auditor. Experience working with self-funded healthcare plans. Claims-processing experience within a third-party administrator, or TPA, environment. Strong analytical, problem-solving, organizational, and interpersonal skills. Clear written and verbal communication skills. Proficiency with Microsoft Excel, Windows, and general PC applications. Ability to collect data, analyze findings, and draw valid conclusions. Strong attention to detail with the ability to maintain focus and accuracy.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].