Claims Auditor, Managed Care (remote)

Claims Auditor, Managed Care (remote) Cedars-Sinai - 4.1 Los Angeles, CA Job Details $27.18 - $42.13 an hour 13 hours ago Benefits Health insurance Dental insurance Qualifications Medicare Insurance dispute resolution High school diploma or GED Health insurance knowledge Full Job Description Job ID 16192 Location Los Angeles, California, United States Job Category Finance Date posted 05/30/2026 Job Description Are you ready to bring your clinical competencies to a world-class Medical Group known for the very highest clinical standards? Do you have a passion for the highest quality and patient satisfaction? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you. The Cedars-Sinai Medical Network is committed to helping primary care and specialist physicians provide excellent care to all their patients, who benefit from convenient access to primary and specialty care physicians and seamless coordination of care between them. As a part of Cedars-Sinai, our physicians and staff are partners in quality health care from a medical center that is consistently recognized as one of the finest hospitals in the country. For the 8th consecutive year, we have been named one of the top 20 Physician Groups in Southern California by Integrated Healthcare Associates (IHA). Why work here? Beyond outstanding benefits, competitive salaries and health and dental insurance we take pride in hiring the best, most passionate employees. Our talented staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for. What will you be doing in this role? The Claims Auditor is responsible for ensuring the accuracy of claims processing based on department policies and procedures, CMS and DMHC regulations. Primary Duties and Responsibilities Conducts detailed audits for compliance with State, Federal and Health Plan regulatory requirements Conducts pre and post payment audits on adjudicated claims in compliance with Cedar-Sinai policies, procedures and payment methodologies Documents audit findings and presents errors to Claims Operations for corrections, root cause analysis and appropriate resolution Provides analysis and prepares recommendations to Management for errors and inconsistences Provides process improvement suggestions to Management Monitors appeals from providers, members and health plans to make sure they are processed accurately and in timely manner. Monitors the daily auditing of processed claims and letters for accuracy. Distributes and monitors multiple projects to make sure deadlines are met. Qualifications Job qualifications Education High School Diploma/GED required Bachelor's Degree healthcare or related field preferred Work Experience 4 years of professional and facility claims processing for Medicare and Commercial products. Must be familiar with provider dispute resolution preferred 5 years of Senior/Lead or Claim Audit experience in a medical claim setting preferred About Us Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents. About the Team With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai's medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond. Req ID 16192 Working Title Claims Auditor, Managed Care (remote) Department MNS Managed Care Business Entity Cedars-Sinai Medical Center Job Category Finance Job Specialty Accounting Overtime Status NONEXEMPT Primary Shift Day Shift Duration 8 hour Base Pay $27.18 - $42.13 Diversity and Inclusion at Cedars-Sinai We are caretakers and innovators committed to the pursuit of equitable healthcare. But health equity is not possible without representation. Our commitment to diversity goes beyond demographics or checking boxes. Our people must reflect the diverse identities, experiences and geographies of the communities and patients we serve - because that's what our patients, colleagues and communities deserve Quality Care and ResearchFor All, By All . Our compensation philosophy We offer a competitive compensation package for our employees. The base pay range shown generally applies to the greater Los Angeles area and may vary based on work location. Our range takes into account the wide range of factors that are considered in making compensation decisions, including knowledge/skills: relevant experience and training, education/certifications/licensure; and other business and organizational factors. The base pay range does not include any incentive payments that may be applicable to a role. Pay Transparency Non-Discrimination Provision (PDF) . Cedars-Sinai is an Equal Employment Opportunity employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address. Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring. At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy.