Support external healthcare claims audits, including pre-pay and post-pay audits
Coordinate and prepare timely audit responses, including medical records and supporting documentation
Participate in audit review cycles, including record requests, findings review, rebuttals, appeals, and recoupment processes
Review audit findings for consistency, accuracy, and alignment with applicable policies
Help identify trends, risks, and recurring audit issues across claims and business units
Partner with internal business units to gather information needed to support audits
Communicate audit findings clearly, including explaining where gaps exist and why audits may be failing
Work collaboratively with teams to identify what changes or controls need to be put in place to improve audit outcomes
Translate audit results into actionable insights that support front-end process improvement
Support ongoing audit readiness initiatives and internal monitoring efforts

High school diploma or equivalent required; associate or bachelor’s degree preferred
2–4 years of experience in healthcare claims auditing or a closely related area
Basic understanding of healthcare claims audits , including pre-pay and post-pay audit processes
Familiarity with the audit lifecycle, including record requests, findings review, appeals, and recoupment
Strong critical thinking and problem-solving skills
Ability to communicate clearly and effectively with both technical and non-technical partners
Comfort engaging with business units to ask questions, gather information, and explain audit-related findings

Competitive Pay
Health Plans with FSA or HSA options
Dental and Vision Insurance
Optional Life Insurance
401K with Company Match
12 weeks of parental leave for birthing parent/ 4 weeks leave for non-birthing parent(s)
Additional Parental benefits to include fertility stipends, free diapers, breast pump
Paid Holidays
PTO Accrual from day one
Employee Assistance Programs

Audit Specialist

Key skills