Medical Claims Auditor

This is a remote position.

Job Title: Medical Claims Auditor

Status: Non Exempt

Work Location: Hybrid: Amherst NY (3 days in office, 2 days remote)

Why this role is important:

Our clients and members count on us to process healthcare claims quickly, accurately, and in compliance with applicable requirements. The Medical Claims Auditor plays a critical role in protecting the quality and integrity of Aither’s claims process by reviewing claims for financial accuracy, proper coding, and compliance with state and federal regulations. Through thorough quality assurance audits, this role helps identify opportunities for improvement, support accurate claim processing, and ensure we continue delivering the high level of service and quality that defines “Being Aither.”

What you’ll do:

• Learn and understand claim processes and work flows.
  

• The Auditor will conduct daily audits of processed claims and assist with other program audits as deemed appropriate by the department manager.
  

• Assist in the development and implementation of auditing and monitoring mechanisms.
  

• Review processed claims with accuracy.
  

• Maintain consistent quality and production standards, by providing feedback from audits and identifying training needs.
  

• Assist with other ancillary department tasks as necessary, including processing claims.
  

• Complete special projects as assigned.
  

• Investigate and research issues as required.
  

• Act as a subject matter expert.
  

• Prepare and provide statistics related to individual and department performance.
  

What you’ll bring:

• High School Diploma or GED.
  

• Minimum of five (5) years experience as a claims examiner or auditor with self-funded health care plans and processing in a TPA environment.
  

• Talent for communicating clearly.
  

• Problem solving skills.
  

• Strong analytical, organizational, and interpersonal skills, with the ability to communicate with members of the team effectively.
  

• PC, EXCEL and Windows experience.
  

• Ability to collect data and draw valid conclusions.
  

• Ability to prioritize.
  

• A precise attention to detail.
  

• Strong ability to focus on a task and ensure accuracy.
  

• Ability to maintain confidentiality.
  

• The motivation to learn and constantly improve processes.
  

Mindset of a team-player - you'll be ready to jump in and help on any Aither task

You might also bring:

• Associates or Bachelors Degree
  

Compensation Range: $21/hr-$30/hr

Actual starting pay within this range will be determined based on several factors, including relevant experience, healthcare or TPA industry knowledge, skills, and overall qualifications. Final compensation will also take into account internal equity and market factors.

Requirements

Benefits

Discover the peace of mind that comes with our well-rounded benefits package—designed to protect your health, finances, and future:

• Health Coverage – Multiple medical, dental, and vision plan options to fit your needs.
  

• Life & Disability Insurance – Employer-paid life insurance plus optional supplemental coverage; short- and long-term disability included.
  

• Retirement Savings – 401(k) plan with automatic enrollment, employer match, and Roth option.
  

• Tax-Advantaged Accounts – Health Savings Account (HSA) for eligible plans, plus Flexible Spending Accounts (FSAs) for healthcare and dependent care.
  

• Easy Enrollment – Core benefits begin the first of the month after 30 days; 401(k) kicks in after 60 days.
  

• Paid PTO and SICK time
  

• 8 Paid Holidays