Claims Auditor/Trainer

Job Summary

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

The Healthcare Claims Auditor/Trainer is responsible for ensuring the accuracy, compliance, and quality of claims processing across all lines of business. This role performs detailed audits, develops and delivers training programs, and provides operational leadership in the absence of Claims Managers or Supervisors. The position collaborates with internal departments and external providers to maintain high standards of adjudication, customer service, and regulatory compliance.

Responsibilities

• Perform detailed audits of claims processing to ensure accuracy, compliance, and quality across all lines of business.
• Develop and deliver training programs for claims processing staff.
• Provide operational leadership in the absence of Claims Managers or Supervisors.
• Collaborate with internal departments and external providers to maintain high standards of adjudication, customer service, and regulatory compliance.

Qualifications

• Minimum 3–5 years of experience in healthcare claims processing, auditing, or training.
• High school diploma or equivalent required; Associate or Bachelor’s degree in healthcare administration, business, or related field preferred.
• Strong knowledge of medical terminology, coding, and regulatory guidelines (HIPAA, CMS).
• Excellent analytical and problem-solving abilities.
• Strong communication and presentation skills for effective training delivery.
• Proficiency in claims processing systems and Microsoft Office Suite.
• Experience with Medicare claims processing and compliance required.
• QNXT system experience highly preferred.

Benefits

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries