Claims Auditor

Job Summary

Working remotely on a full-time basis, the Claims Auditor will investigate claims liability, process claims according to existing policies, and communicate with clients to resolve claim 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 with appropriate plans and policies
• Set and adjust claims reserves, authorizing checks for liability amounts and communicating with clients regarding coverage decisions

Required Qualifications

• Bachelor's Degree in Business Administration or a related field, or equivalent education and experience
• Strong medical knowledge, including ICD, CPT, medical terminology, COBRA, and HIPAA
• Ability to read and interpret claims reports and procedural manuals
• Intermediate proficiency in Microsoft Office applications (Excel, Access, PowerPoint, Word)
• Advanced organizational and analytical skills, with the ability to manage multiple tasks simultaneously