Medical Claims Auditor

TL;DR

Medical Claims Auditor (Medicare): Review claims for billing and coding issues indicating fraud, waste, and abuse with an accent on Medicare coding policies and correct coding initiatives. Focus on identifying control and audit opportunities, supporting provider conversations, and managing audit workloads for compliant FWA programs.

Location: Remote - USA

Salary: $90,000 - $100,000 USD

Company

Reinventing health insurance by combining data analytics with personalized care to improve member health outcomes.

What you will do

• Partner with Clinical, Claims, and SIU teams to review claims retrospectively for billing, coding issues, and FWA indicators.
• Identify control opportunities and possible audit targets to mitigate FWA.
• Support annual FWA audit goals and provider discussions on findings.
• Manage audit workload for timely, accurate results while ensuring regulatory compliance.
• Collaborate on targeted projects with senior team members across disciplines.

Requirements

• 3+ years of coding and auditing experience (CMS regulations preferred).
• Strong knowledge of National Rules of Correct Codification (CMS CCI Manual and tables).
• Experience with claims systems, workflow tools, Microsoft Office or Google Suite.
• Experience in health insurance (Medicare Advantage a plus).
• Broad coding knowledge: DME, Outpatient, ASC, Physician.

Culture & Benefits

• Competitive base salary, equity, performance bonuses, 401k matching, and compensation reviews.
• Comprehensive medical, dental, vision coverage for employees and families.
• Remote-first culture with No-Meeting Fridays, monthly holidays, flexible time-off, mental health resources.
• Professional development: learning programs, mentorship, funding, performance feedback.
• Additional perks: ESPP, office setup reimbursement, cell/internet stipend, paid parental leave.