Claims Auditor

Job Summary

Working remotely in Georgia, the full-time Claims Auditor will investigate claims liability, process claims accurately according to existing policies, and communicate with clients to resolve processing issues.

Key Responsibilities

• Review and interpret employer plans of health coverage and excess insurance policies for individual claims
• Audit submitted claim documents for accuracy and compliance, determining liability and setting claims reserves
• Communicate with third-party administrators and clients to resolve claim processing issues effectively

Required Qualifications

• Strong medical knowledge, including ICD, CPT, medical terminology, COBRA, and HIPAA
• Ability to read and interpret documents such as Plan of Benefits and claim reports
• Advanced organizational and analytical skills with the ability to manage multiple tasks simultaneously
• Intermediate proficiency in Microsoft Office applications, including Excel and Word
• Solid written and verbal communication skills with an emphasis on confidentiality and diplomacy