Claims Quality Auditor

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Location: Onsite or Remote

Work Arrangement: Flexible Hybrid

Work Schedule: 8:00 AM - 4:00 PM PST

Posted Date: 05/06/2025

Salary Range: $30.56 - $60.82 Hourly

Employment Type: N/A

Job #: 24175

Join a world-class health organization and provide specialized expertise to ensure the efficient operation of a complex health system. At UCLA Health, the Claims Quality Auditor will:

• Audit all examiners' claims (paid, pending, denied) for accuracy, benefit application, authorization, contract interpretation, and compliance
• Research inquiries/appeals related to over and under-payments
• Compile and maintain statistical data
• Maintain departmental production and quality standards

We’re seeking a self-motivated, detail-oriented, deadline-driven individual with:

• High school diploma, GED, or equivalent
• Four or more years of medical claims payment experience in an HMO environment
• Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS
• Understanding of Medicare Guidelines and COB
• Knowledge of medical terminology
• Experience in benefit determination and claims adjudication
• Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM
• Understanding of reimbursement methodologies for professional and facility claims
• Strong organizational skills
• Proficiency with Microsoft Office
• Knowledge of claims adjudication systems
• Flexibility and adaptability

UCLA Health is a renowned health system with four hospitals and over 250 clinics across Southern California, home to the David Geffen School of Medicine. Join us for a rewarding career with greater challenges and fulfillment.