<p>General Information</p> <p>Press space or enter keys to toggle section visibility</p> <p>Work Location: Los Angeles, USA</p> <p>Onsite or Remote</p> <p>Flexible Hybrid</p> <p>Work Schedule</p> <p>8:00 AM - 4:00 PM PST</p> <p>Posted Date</p> <p>05/06/2025</p> <p>Salary Range: $30.56 - 60.82 Hourly</p> <p>Employment Type</p> <p>2 - Staff: Career</p> <p>Duration</p> <p>N/A</p> <p>Job #</p> <p>24173</p> <p>Primary Duties and Responsibilities</p> <p>Press space or enter keys to toggle section visibility</p> <p>Take on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health.</p> <p>The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the auditor. You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract interpretation, Division of Financial Responsibility (DOFR), and application/compliance with policies and procedures. You will:</p> <ul> <li>Research over and under-payment inquiries/appeals </li><li>Compile and maintain statistical data consistent </li><li>Maintain departmental production and quality standards </li></ul> <p>Salary Range: $30.56 - $60.82 Hourly</p> <p>Job Qualifications</p> <p>Press space or enter keys to toggle section visibility</p> <p>We're seeking a self-motivated, detail-oriented, deadline-driven individual with:</p> <ul> <li>High school diploma, GED or equivalent </li><li>Four or more years of medical claims payment experience in an HMO environment </li><li>Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS </li><li>Understanding of Medicare Guidelines and COB </li><li>Knowledge of medical terminology </li><li>Experience in benefit determination and claims adjudication </li><li>Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM </li><li>Understanding of professional and facility reimbursement methodologies </li><li>Strong organizational skills </li><li>Computer proficiency with Microsoft Office </li><li>Knowledge of claims adjudication systems </li><li>Flexibility and adaptability </li></ul> <p>UCLA Health is a world-renowned health system with four award-winning hospitals and more than 250 community clinics throughout Southern California. We are also home to the David Geffen School of Medicine, a highly respected leader in the development of breakthrough medical research and outstanding clinical professionals. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.</p> <p>As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.</p>