Medical Audit Lead
$79,000–$158,500 year
RemoteUnited States
Job Summary
Lead complex medical claims audits from planning through final reporting, interpreting plan documents, benefit provisions, and pricing methodologies to identify billing and adjudication issues. Review claims for accuracy using analytics tools to detect trends and exceptions, then develop evidence-based findings to challenge vendor responses. Serve as the primary client contact, communicating audit progress and results while managing multiple priorities and deadlines. This fully remote role requires deep expertise in the medical claims payment process and strong project management skills to support high-quality client presentations.
Required Qualifications
- 5+ years of experience in medical claims auditing, medical claims operations, benefits administration, and/or carrier/TPA environments
- Deep working knowledge of the medical claims payment process
- Strong understanding of the core components of a medical claim and the ability to identify issues through manual review
- Demonstrated ability to assess claim accuracy and support defensible audit conclusions
- Experience evaluating and rebutting vendor or carrier responses
- Strong project management and organizational skills
- Excellent client-facing, written, and verbal communication skills
- Bachelor's degree in healthcare, business, finance, analytics, or a related field, or equivalent experience
Desired Qualifications
- Experience leading complex audits or large-scale claim review projects
- Experience using audit analytics platforms or SaaS-based audit tools
- Strong Microsoft Office skills
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