Claims Auditor

The Claims Auditor plays a crucial role in the Claims Department by analyzing procedures, policies, and reports to ensure the appropriate resolution of claims and the maintenance of the claims system. This role involves coordinating the generation and review of claims reports and ensuring compliance with company guidelines.

• Assist the Claims Director in training and educating the Claims department staff.
• Coordinate the generation and review of claims audit, status, and pending claims reports, ensuring authorized claims are paid in accordance with company guidelines.
• Investigate, process, and track resolution adjustments including refunds, overpayments, and underpayments.
• Act as a resource for providers, members, insurance carriers, attorneys, and co-workers, researching and responding to questions promptly.
• Create, maintain, and generate system reports.
• Interface with the Claims Director to ensure claims processing functions meet legal and contractual requirements regarding health plan audits.
• Prepare and present weekly and monthly reports reflecting staff and departmental quality statistics.
• Review and audit member liability denials and Provider Dispute Resolution claims to ensure compliance with regulatory requirements and passing audit scores from health plans.

• Compliance
• Claims management
• Claims analysis
• Knowledge of DOFR
• Lab Claims
• Familiarity with UB-92 and HCFA-1500

• Knowledge of HMO/IPA operations and medical terminology.
• Understanding of ICD-10, RVS, and CPT coding.
• Knowledge of Medicare and Medi-Cal guidelines.
• Proficiency in 10-key skills by touch.
• Excellent communication skills.
• Knowledge of system applications.
• Ability to function effectively under time deadlines.
• Strong organizational skills.
• Bilingual skills in Spanish/Chinese preferred.

The work schedule is Monday through Friday, from 07:00 am to 03:30 pm. Please note that orientation times may differ from the shift times listed. The work environment supports a collaborative and efficient atmosphere, aiming to maintain the highest standards of claims auditing.

This is a Contract position based out of Whittier, CA.

The pay range for this position is $21.00 - $28.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully onsite position in Whittier,CA.

This position is anticipated to close on Mar 12, 2026.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

Salary : $21 - $28