Senior Auditor, Healthcare Claims

🔥 7 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $95k - $120k / year

⏰ Full Time

🟠 Senior

🔎 Auditor

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Curative

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2020

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

Curative is an employer-focused health insurance company offering a next-generation group health plan that emphasizes affordability, engagement, and simplicity. Their plans promise $0 in-network copays, $0 deductibles, and a single competitive monthly premium, along with a broad provider network, telehealth, an extensive $0-preferred prescription formulary, care navigators, and the Curative Cash Card to eliminate out-of-pocket costs in many settings. Curative markets to employers and brokers while providing members with resources like a Baseline Visit, care programs, online portals, and pharmacy services, and holds an A- rating from AM Best and HITRUST r2 certification.

📋 Description

• Design and implement an enterprise claims quality assurance program focused on defect reduction and operational excellence. • Develop statistically valid sampling methodologies and quality scorecards. • Establish auditing frameworks that support continuous improvement and measurable quality outcomes. • Create audit dashboards and reporting that provide actionable operational insights to leadership. • Perform comprehensive audits of professional, institutional, behavioral health, and ancillary claims to validate adjudication accuracy, contract compliance, and regulatory adherence. • Conduct random sampling audits, targeted audits, focused reviews, and high-risk claims analysis across all lines of business. • Identify trends, root causes, and systemic issues contributing to payment inaccuracies, provider abrasion, or operational inefficiencies. • Collaborate with Claims Operations, Payment Integrity, Compliance, Provider Relations, Utilization Management, and Information Technology teams.

🎯 Requirements

• Required: Bachelor’s degree in Healthcare Administration, Business, Health Information Management, or related field • 7+ years of healthcare claims operations, auditing, payment integrity, or quality assurance experience within a health plan, managed care organization, TPA, or payer environment • Strong experience auditing Commercial, Medicare, and/or Medicaid claims • Experience performing random sampling audits and targeted compliance reviews • Experience analyzing root causes of claims processing errors and implementing corrective actions • Experience supporting regulatory audits and compliance initiatives • Strong understanding of provider reimbursement methodologies and claims payment workflows • Preferred: Master’s degree in Healthcare Administration, Business Administration, or related field • Professional certifications such as CPC, CPMA, CFE, RHIT, RHIA, Six Sigma, or Healthcare Quality certifications.

🏖️ Benefits

• Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.) • $0 copays and $0 deductibles (with completion of our Baseline Visit ) • Preventive and primary care built in • Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged) • One-on-one care navigation • Chronic condition programs (diabetes, weight, hypertension) • Maternity and family planning support • 24/7/365 Curative Telehealth • Pharmacy benefits • Comprehensive dental and vision coverage • Employer-provided life and disability coverage with additional supplemental options • Flexible spending accounts • Flexible work options: remote and in-person opportunities • Generous PTO policy plus 11 paid annual company holidays • 401K for full-time employees • Generous Up to 8–12 weeks paid parental leave, based on role eligibility.