Claims Auditor

Job Summary

To support the claims processing team, the full-time remote Claims Auditor will investigate claims liability, process claims according to policies, and establish reserves for claim liability.

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 with appropriate plans and policies
• Communicate with third-party administrators and clients to resolve claim processing issues

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 (Excel, Access, PowerPoint, Word)
• Knowledge of industry changes and legal updates relevant to the insurance sector