Claims Auditor Lead
Full-time
Elevance Health
Claims Auditor Lead Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. The Claims Auditor Lead is responsible for processing high dollar claims within Service Operations. Responsible for pre and post payment and adjudication audits of high dollar medical and pharmacy. Serves as the subject matter expert for the unit. Primary duties may include, but are not limited to:
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
- Responsible for all team training including but not limited to new hires, cross training, new product and system enhancements.
- Conducts audits for new hires and/or any team member learning a new skill.
- Reviews, interprets and maintains records of quality and productivity for entire team.
- Coaches, mentors and develops associates to ensure processes, guidelines and tools are utilized correctly.
- Utilizes inventory management strategies to monitor priorities and ensure timely turnaround of all claims.
- Responsible for creating, updating and maintaining departmental policy and claims auditor procedure manuals for accuracy.
- Independently analyzes and makes decisions on complex claim audit issues.
- Serves as subject matter expert on policy, workflow and technical questions.
- Interfaces with all levels of support including but not limited to production support, medical management, provider /vendor contracting and other audit teams.
- Partners with Management on complex claims reviews and resolution.
- Responsible for reviewing and resolving shared mailbox issues.
- Interprets contracts, prepares monthly reports, and attends meetings as subject matter expert when requested.
- Manages projects as assigned and may work across different platforms or lines of business.
- Reviews and responds to external audit requests.
- Performs audit reviews of and may adjudicate complex high dollar claims by completing an end to end audit with final approval authority.
- Proficiency in Microsoft Office Suite is highly preferred.
- Commercial Claims experience is highly preferred
- CI&W and WGS experience is highly preferred.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on us.fitly.work for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Claims Auditor Lead in Atlanta, GA vacancy
- ...Claims Auditor Lead Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement...ClaimsWork at officeDay shift2 days per week1 day per week
- Elevance Health is seeking a Claims Auditor Lead to oversee high-dollar claim audits, pre- and post-payment reviews, and adjudication processes within Service Operations. The role emphasizes training, mentoring, and maintaining audit quality across a team operating in a...ClaimsWork at office
$80k - $150k
A government services firm in Atlanta is seeking a Senior Auditor to conduct medical claims data analysis and forensic investigations. The ideal candidate will have at least 5 years of experience in forensic financial accounting and will be responsible for analyzing complex...Claims- ...as a Senior Environmental, Health, and Safety (EHS) Compliance Auditor, EHS Compliance Program Manager. The selected candidate will join... ...require to be located there.Responsibilities:Plan, participate, and lead various styles of audit programs.Conduct/lead EHS compliance...SuggestedWork at officeLocal areaWorldwideRelocation
- Location: Atlanta, Georgia, United StatesCompany: Emory HealthcarePosted: 2026-09-01Emory Healthcare is seeking an Outpatient Coding Auditor to implement and maintain a compliance plan for outpatient coding and reimbursement, and to assist the Coding Manager with...Suggested
$80k - $150k
...Overview CGS Federal (Contact Government Services) is seeking a Senior Auditor who will assist district legal staff by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses. These analyses...ClaimsFull timeFlexible hoursCGS Federal (Contact Government Services)
Atlanta, GA1 day ago- ...Senior Auditor Employment Type: Full Time, Mid-level CGS is seeking a Senior Auditor who will assist the district legal staff by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses...ClaimsFull timeRemote workFlexible hours
Contact Government Services LLC
Atlanta, GA4 days ago - Reserv is seeking a Team Lead in Atlanta to guide the Commercial Auto Claims staff. You will balance management duties with hands-on claims work, driving efficiency through analytics and technology. Ideal candidates have 5+ years in insurance claims, 3+ years leading a...ClaimsRemote job
- ...Lead Auditor This position is posted on a continuous basis and does not have a fixed application close date. Applications are reviewed on an ongoing basis. Location: Americas region, including US, Canada, Mexico, and South America including Caribbean Responsibilities...Full timeFor contractorsWork experience placementRemote work
- Reserv in Atlanta is seeking a Team Lead for Claims to support the Claims Manager and oversee the Commercial Transportation Claims adjusting staff. The ideal candidate will have extensive experience in insurance claims, particularly in commercial transportation, combined...ClaimsRemote job
$86k
...comprehensive audits of automotive dealerships and evaluate warranty and fixed-operations processes. In this role, you will review warranty claims, repair documentation, record-retention practices, dealership processes, and KPI data to identify compliance gaps, potential...ClaimsFull timeWork at office- Northside Hospital is seeking a Medical Records Auditor to review documentation and ensure accurate CPT, ICD-10, HCPCS coding and modifier assignments for patient claims. The Auditor will follow policy for audit schedules and deliver professional reports to physicians and...Claims
- EY's Forensics Insurance and Federal Claims Services helps clients recover from disasters by offering grants management, compliance and... ...local projects, build client relationships, verify compliance, and lead project teams. Travel to client sites and some in-office...ClaimsWork at officeLocal area
- EY is seeking an experienced insurance claims Manager to lead complex commercial loss engagements, including property, BI, cyber, and construction claims. You’ll work with clients, brokers, insurers, and specialists to develop strategies, manage teams, and guide all stages...Claims
- Elevance Health is hiring a Provider Auditor Senior to lead on-site reviews of medical charts, notes, itemized bills, and provider contracts to ensure claims are paid per contract and policy. The role involves selecting providers for review, scheduling, analyzing data,...ClaimsContract work
- Elevance Health is seeking a Provider Auditor Senior - Payment Integrity Complex and Clinical Audit to conduct on-site reviews of medical charts, notes, and contracts to ensure correct claim payments. This role supports a hybrid work model requiring in-office presence...ClaimsWork at office2 days per week1 day per week
- ...Auditor Position at Northside Hospital Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly... ...-10 and HCPCS codes and modifiers are correct for the selected claims. The Auditor will follow Northside policy and procedure for annual...ClaimsWork experience placementWork at officeWeekend work
- ...Provider Auditor Senior This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity,... ...medical notes, itemized bills and provider contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement...ClaimsContract workTemporary workWork experience placementWork at officeLocal area2 days per week1 day per week
- ...Job Summary CGS is seeking a highly skilled Auditor to provide general auditing and accounting services in support of fraud investigations... ...of data such as bank records, financial records, healthcare claims, tax records, correspondence, policies, other documentary...ClaimsWork experience placementInterim roleWork at officeLocal areaFlexible hours
Cgsfederal
Atlanta, GA1 day ago - NorthPoint Search Group is seeking a Senior SOX Auditor based in Atlanta, GA to lead and support SOX 404 compliance efforts and ICFR testing. You’ll act as a liaison between process owners and testing teams, drive improvements, and maintain documentation related to controls...
- ...and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and... ...people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long‑standing challenges of...ClaimsWork at officeRemote work
Reserv Claims Analysis, LLC
Atlanta, GA3 days ago - ...Auditor CGS is seeking a highly skilled Auditor to provide general auditing and accounting services in support of fraud investigations... ...of data such as bank records, financial records, healthcare claims, tax records, correspondence, policies, other documentary evidence...ClaimsWork experience placementInterim roleWork at officeLocal area
- ...ChainJob Number: 190971Apply: JobThe Ocean Logistics Procurement Lead is the regional subject‑matter expert for marine logistics... ...carrier compliance and manage escalation processes Liaise through claims processesAnalyze financial performance and lead action plans for...ClaimsContract workWorldwideFlexible hours
- Northside Hospital Inc. is seeking an experienced Auditor to review medical record documentation and ensure accurate ICD-10, CPT, and HCPCS coding for claims. The role includes conducting audits, delivering findings to physicians and leadership, and educating staff based...Claims
- ...flexibility includes Farmington, CT and several major U.S. cities. The role emphasizes relationship management with Program Administrators, claims liaison, and market development while maintaining high underwriting discipline and reporting to senior management. #J-18808-Ljbffr...Claims
$55 per hour
...Dallas, TX/Atlanta, GA Work Mode: Hybrid Responsibilities Lead current-state and future-state process mapping across assigned... ...business rules, controls, and workflow gaps. Capture audit, claims, G&A, and regulatory process details with clear traceability to...ClaimsHourly pay- ...Are: Accenture is a global professional services company with leading capabilities in digital, cloud and security. Combining unmatched... ...upgrades, and application support. Epic Tapestry certification in Claims, E&E, Benefits Engine, CRM, or UM - strongly preferred and the...ClaimsFull timeWork experience placementLive inWork at officeLocal area
$143k - $191k
...ground in Atlanta—partnering directly with the site's applications lead to localize, run, and scale the analytics our production floor... ...: Should you encounter any questionable or fraudulent outreach claiming to be from Anduril, please report it immediately to ****@*****.***...ClaimsFull timeWork experience placementLocal areaImmediate start- Wilson Elser in Atlanta is seeking a National Litigation & Claims Management Attorney to lead discovery strategy and oversee multi-jurisdictional litigation for a large national client. You will shape discovery approaches, drive efficient processes, and partner with clients...ClaimsRemote job
- CNA Insurance is seeking a senior procurement leader to guide vendor strategy and contracting to enable Claims strategy and operational excellence. The role requires directing a team, driving market intelligence, and developing category plans with cross-functional partners...Claims
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Claims Auditor Lead. Be the first to apply!
