Claims Auditor - TPA

Job description

WHAT WE’RE LOOKING FOR The Claims Auditor ensures claims are processed in accordance with contractual, regulatory, and internal performance requirements. The individual in this role supports quality assurance efforts by auditing claims processing activity, documenting findings, and contributing to the continuous improvement of operational standards and compliance. A GLIMPSE INTO YOUR DAY Performs operational and quality audits of claims processing activity to ensure accuracy, compliance, and adherence to contractual, regulatory, and internal guidelines. Reviews claims files, documentation, and processing workflows to confirm established procedures and standards are being followed. Documents audit results and prepares timely, accurate audit reports, findings, and supporting records. Tracks audit outcomes and identifies trends, recurring issues, or opportunities for improvement. Communicates audit findings to appropriate stakeholders and supports follow‑up actions as directed. Actively participates in the development, review, and refinement of operational policies, procedures, and quality standards. Supports internal performance and compliance initiatives by providing data, insights, and documentation as needed. Facilitates collaboration and feedback across functional teams to promote consistent claims processing practices. Facilitates meetings related to audits, quality initiatives, or process improvements, as needed. Effectively utilizes available technology and tools, including emerging and AI‑enabled solutions, to support efficient workflows, accuracy, and a positive client service experience. Special projects and other duties as assigned. WHAT SUCCESS LOOKS LIKE IN THIS ROLE High school diploma or equivalent. Minimum 2 years of experience in claims processing and auditing. Demonstrated ability to review claims activity for accuracy, consistency, and compliance with established rules and guidelines. Strong attention to detail and analytical skills. Effective verbal and written communication skills. Ability to document findings clearly and maintain accurate records. Proficiency in Microsoft Word and Excel; ability to learn new systems and software applications. Ability to manage multiple priorities and meet deadlines in a structured environment. Commitment to confidentiality and appropriate handling of sensitive information. Consistently demonstrates professionalism, tact, and discretion. WHY CHOOSE RELATION? Competitive pay. A safe and healthy work environment provided by our robust benefit program including family health and wellness programs, 401K, employee assistance programs, paid time off, paid holidays and more. Career advancement and development opportunities. . Note: The above is not all encompassing of the full position description. Relation Insurance Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Relation, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is presented within this posting. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. . $23.00 - $33.65