Aggregate Claims Auditor

Job Summary

Working remotely on a full-time basis, the Aggregate Claims Auditor will investigate claims liability, process claims according to policies, and establish reserves for claim liability while ensuring compliance with contract terms.

Key Responsibilities

• Review and interpret employer health coverage plans and excess insurance policies
• Audit monthly and year-end aggregate claims for payment, following up on missing documentation as necessary
• Communicate with third-party administrators and clients to resolve claim processing issues

Required Qualifications

• Bachelor's Degree in Business Administration or a related field, or equivalent experience
• Two years of relevant professional experience in auditing and claims
• Broad knowledge of principles and practices related to claims auditing
• Strong medical knowledge, including ICD10, CPT, and medical terminology
• Ability to read and interpret complex documents such as benefit plans and claim reports