Medical Claims Auditor
Clover Health · United States · US
Utilization Review
Remote
physician
Dentist
Demand78
Career growth72
Healthcare fit62
Remote potential65
Salary band
USD 92k – 120k
5-year outlook
Likely stable mid-level compensation in Medicare Advantage, payer compliance, and health-tech payment integrity. Exact salary is not provided, so expect ranges aligned with CPC-certified claims auditors and FWA specialists rather than clinical salaries.
Clinical license
Not required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-29
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- Profession fit
- physician, Dentist
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth considering if you already have CPC/coding-audit experience and want payer-side FWA, compliance, and health-tech exposure. Clinicians without coding credentials should build that foundation first rather than apply cold.
Who should apply
CPC-certified nurses, doctors, or healthcare graduates with 3+ years of coding/auditing experience; clinicians with Medicare Advantage, claims review, or compliance exposure; coding auditors seeking health-tech and FWA specialization.
CV angle
Lead with CPC and any coding/auditing metrics: claims reviewed, denial/recovery outcomes, CMS/Medicare Advantage audit exposure, FWA investigations, provider feedback, and use of claims systems or AI-flagged work queues. Reframe clinical documentation knowledge as a strength for validating coding and explaining audit findings—do not claim audit experience you do not have.
Skills to highlight
- Medical coding (DME, outpatient, ASC, physician)
- Claims auditing (prepayment and retrospective)
- FWA compliance and investigations
- CMS/CCI and Medicare coding rules
- Medicare Advantage claims knowledge
- Data analysis and AI-flagged claim validation
- Provider communication and compliance feedback
- Audit workload management
Role summary
Audit medical claims for coding and billing issues, identify FWA risks, validate AI-flagged claims, and support prepayment and retrospective Medicare Advantage audit programs.
We publish our own intelligence summary, never the full job description. Always confirm details with the employer when you apply.