Primary Duties and Responsibilities
The Claims Auditor is responsible for performing pre-payment and post-payment audits ensuring financial and processing accuracy, compliance with regulatory and health plan requirements of claims processed.
The Claims Auditor is responsible for auditing and confirming accuracy of the loading of:
- Fee schedules
- Provider contracts
- Payor contracts
- Benefits
- Code changes
- System enhancements
Education and Experience
- High School Diploma or equivalent
- 5 years of experience in a medical claims processing environment
- Knowledge of HMO/managed care regulatory guidelines
Preferred:
- Experience with Epic Tapestry system
- 3 years experience in claim audits, revenue recovery, or claims system configuration
License Required
N/A
License Preferred
N/A
Certifications Required
N/A
Certifications Preferred
N/A
About UsHoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year.
For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy.
Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes.
Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.
To learn more about Hoag’s awards and accreditations, visit: https://www.hoag.org/about-hoag/awards-accreditations/.
Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.
Hoag Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Hoag and has not been reviewed or approved by Hoag.
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Healthcare Strength — Health, dental, vision, mental health, disability, and wellness programs are extensive, with additions like FSAs and pet insurance. These offerings are presented as comprehensive and a meaningful component of total rewards.
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Leave & Time Off Breadth — Generous PTO, paid holidays and sick time, and parental leave feature prominently. These time-off provisions are described as supportive of work-life balance across roles, including fellowship programs.
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Career-Linked Recognition & Rewards — Tuition reimbursement, continuing education stipends, certification bonuses, and a clinical ladder link development to higher pay and broader involvement. Promote-from-within practices further connect performance and growth to compensation over time.
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What We Do
Since 1952, Hoag has been serving the local communities of Orange County by providing personalized health care services of an unsurpassed level. Hoag Digital Health is a new customer-centric product management, design, and engineering unit on a mission to bring together Hoag's nationally renowned care in key medical specialties with the everyday experience of primary, urgent, and preventative care and well-being through a variety of digital mediums.
Why Work With Us
To date, we have been helping fundamentally rethink the care experience for multiple customer groups with hybrid digital-physical solutions – from becoming go-to guides for first-time parents delivering at Hoag through re-imagining the primary care and annual wellness experience to improving Hoag’s “digital front doors,” including its websites.
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