Claims Auditor

Smart Data Solutions, a leading provider of data management, claim routing and workflow solutions to health plans and TPAs, is looking for a Claims Auditor to join our team

What you’ll be doing?
- Plan and perform audits of enrollment, eligibility, claims processing, and other operational areas for accuracy, timeliness, and compliance with regulatory and contractual requirements.
- Develop and maintain audit work plans, checklists, sampling methodologies, and audit schedules.
- Review case files, transactions, and system records to verify adherence to state and federal healthcare regulations (e.g., Medicaid, Medicare, ACA) and applicable accreditation standards.
- Document audit findings, root causes, and risk levels in explicit, well-organized audit reports.
- Present audit results to management and collaborate with department leaders on corrective action plans.
- Track and follow up on corrective action items to confirm timely remediation and closure.
- Support internal audits, as needed.




- Maintain audit documentation in accordance with organizational retention and confidentiality requirements.
- Identify trends and systemic issues across audit results and recommend process improvements.
- Serve as an escalation point for claims that cannot be resolved by processors, ensuring accurate and timely resolution.
- Process claims directly on an occasional basis (e.g., during ramp-up/ramp-down periods, backlog reduction, or urgent processing needs), applying the same standards of accuracy and timeliness expected of examining staff.
- Participate in departmental and client training and calibration meetings as needed to maintain consistency between audit and processing standards.
- Ensure compliance with all client requirements, regulatory guidelines, and internal policies, including HIPAA.
- Flexible working in any shift & performing other duties as assigned.
- Work from office is mandatory

The duties set forth above are essential job functions for the rol

📌 Claims Auditor (Perungudi)
🏢 Smart Data Solutions
📍 Perungudi