Claim Auditor I
Core
Auditing behavioral and medical claims for Texas Medicaid and CHIP programs to ensure payment integrity and regulatory compliance.
Role type
Claims auditor
Builds
Accurate claim payments and audit reports for Medicaid/CHIP programs
Domain
Healthcare administration / Public health insurance
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medical claims processing, claim adjudication, benefit plan coordination, medical terminology, medical coding, federal program knowledge (Medicaid/CHIP), claim form handling (UB-1450, HCFA CMS 1500), Microsoft Office (Word, Excel, Access)
Preferred skills
Experience in health plan/payor environment, pre-auditing high-dollar claims
Responsibilities
Conduct post-claims reviews on routine to moderate complexity claims, pre-audit high-dollar claims, communicate audit results to managers and claims departments, ensure alignment with regulatory standards and contracts
Seniority
Entry-level to Mid-level
