Summary The Claim Auditor is responsible for ensuring that their assigned sampling of adjudicated claims for Texas Medicaid and CHIP programs are audited on a monthly basis. The Claim Auditor is responsible for routine and moderately complex audits on paper and electronic claims for payment integrity in alignment with regulatory standards, timelines, business policy, provider and HHSC contracts, appropriate coding and system configuration. Audits may include physician, outpatient, inpatient, facility, and long term services and support claims. Results of the audits are to be communicated to the Claims Department. Production and operational reports must be provided to the Director of Complia
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