Medical Claims Auditor

Job Description

Job Description

Job Title : Medical Claims Auditor - RN Auditor

Location : Massachusetts – 90% Remote

Job Type : 1 Year Contract - Potential for Perm Hire

Hours : 40 hours per week

Start Date : December 1, 2025

Job Description

We are seeking a qualified Auditor with healthcare experience to support Program Integrity activities for a state healthcare program. This role focuses on conducting both desk and onsite audits of healthcare providers to ensure compliance with contractual standards and regulatory requirements.

Responsibilities

• Conduct audits (onsite and desk-based) of healthcare providers in alignment with state program guidelines
• Travel locally as required to perform onsite audits (1-4 times per month)
• Evaluate claims and provider documentation for compliance and accuracy
• Collaborate with internal audit teams and leadership to maintain audit quality standards
• Document findings and present audit outcomes clearly and effectively
• Use Microsoft Office tools to manage reports, track audits, and communicate outcomes
• Adhere to defined Service Level Agreements (SLAs) for audit completion and reporting

Required Qualifications

Preferred Qualifications

Certifications & Licensing

Interview Process

How to Apply

If you meet the qualifications and are interested in this opportunity, please submit your resume and a brief cover letter detailing your relevant experience.