Job Title:
Auditor II
Location:
Detroit, MI (Remote)
Schedule:
Monday – Friday, Standard Business Hours
Type:
W2 Contract
Pay Rate:
$38–$42/hour
Summary
The Auditor II supports healthcare audit activities by retrieving, validating, and analyzing claim documentation to ensure compliance with regulatory and internal requirements. This role partners with cross-functional teams to respond to audit inquiries, resolve discrepancies, and ensure timely, accurate audit submissions. The ideal candidate has strong Medicare Advantage and claims experience, advanced coordination skills, and the ability to clearly communicate audit findings.
Key Responsibilities
- Retrieve, review, and validate documentation from claims systems to support audit requests
- Conduct detailed claim reviews to verify accuracy, completeness, and compliance with CMS regulations
- Partner with internal stakeholders to address audit inquiries, resolve documentation gaps, and ensure timely submissions
- Track, manage, and prioritize audit deliverables, ensuring deadlines and quality standards are consistently met
- Identify risks, discrepancies, or errors within audit samples and support resolution efforts
- Determine appropriate documentation required to validate claim payments and audit outcomes
- Monitor and support implementation of corrective actions to ensure audit findings are addressed
- Prepare, review, and refine audit responses to ensure clarity, accuracy, and completeness
- Communicate audit findings and updates effectively to internal teams, both verbally and in writing
- Maintain strong organization of audit records, documentation, and communications
Required Qualifications
- Bachelor’s degree in Business Administration, Healthcare Administration, Accounting, Finance, or related field
- Healthcare experience with medical claims and benefits
- Strong experience supporting Medicare Advantage products
- Knowledge of CMS rules and regulatory requirements
- Advanced project and workflow coordination skills
- Strong analytical skills with the ability to review and interpret claim data
- Excellent written and verbal communication skills
Preferred Qualifications
- Experience with IKA or NASCO claims processing systems
- Advanced Excel skills (data analysis, reporting, tracking)
- Prior audit, compliance, or claims review experience in a healthcare environment
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