Claims Auditor

About the role

Centivo is seeking a Claims Auditor to conduct pre‑payment, post‑payment, and adjudication audits across multiple employer groups and product lines. The role ensures the integrity of claims operations, supports the Claims Quality Review program, and helps maintain high‑quality, affordable healthcare for members.

Key responsibilities

• Audit internal and external claims for processing, payment, and financial accuracy, following standard processes and client plan descriptions.
• Prepare audit reports with decision methodology for procedural and monetary errors, supporting quality reporting and trend analysis.
• Communicate corrections and adjustments to Claims Adjustors, especially for high‑dollar pre‑payment audits, and verify their completion.
• Identify and escalate trends from quality reviews and collaborate with QA leads, supervisors, and managers on corrective actions.
• Participate in projects as a subject‑matter expert, and assist with policy creation, training, and mentoring of Adjustors.

Required profile

• High School diploma or GED required; associate or bachelor’s degree preferred.
• Minimum three years experience as a claim adjustor or auditor in a self‑funded health‑care TPA environment.
• Strong analytical, organizational, and interpersonal abilities with attention to detail.

Required skills

• Experience with El Dorado‑Javelina or Health Rules Payer (HRP) claims processing systems.
• Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.