Claim Auditor I-Health Plan
Cook Children's Health Care SystemFort Worth, Texas, United States
Posted March 30, 2026
Full Time
About the Company
Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region.
Job Description
The Claim Auditor I is responsible for auditing behavioral and medical claims and ensuring quality metrics are met by conducting post claims reviews on posted claims for Texas Medicaid and CHIP programs. The individual in this position performs all job functions in accordance with HIPPA and security rules as it relates to protected health information and has a thorough understanding of claims life cycle.
Requirements
- Associates degree required or a minimum of 5 years of claims/audit experience
- 7-10 years of medical claims processing, claim adjudication, coordination of benefit plan, medical terminology and coding
- Must have strong organizational skills, problem solving and decision making skills
- Advanced knowledge of claim adjudication and benefit plan application for Medicaid and CHIP programs
- Microsoft Office skills including Word, Excel and Access
- Excellent customer service skills with ability to explain complicated benefit issues to staff and providers
