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Claims Auditor
None • Irvine, CA, US • published 2026-09-29 08:55:30.928865
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**Job Description Summary** =========================== This position reports to the Supervisor of Payment Integrity and performs in\-depth audits to ensure existing health (medical/dental) benefit plans of Western Growers Assurance Trust and Pinnacle Claims Management, Inc. clients are in compliance with the respective employers’ summary plan descriptions. **Duties And Responsibilities** =============================== *Claims Auditing* * Perform routine and moderately complex audits on paper and electronic claims for payment integrity in alignment with regulatory and timelines standards, business policy, and contract terms. * Ensure appropriate coding and system configuration of claims with the ability to extract and audit exception audit reports. * Research claim processing problems and errors to determine their origin and appropriate resolution. * Prepare reports and summarize observations and recommendations for management. * Participate in communication with management regarding trends in order to improve claims processing accuracy and documented business rules for incorporation into training programs, policies, and procedures. * Perform special project audits and reviews as ...
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