Claims Auditor

Job Summary

To support the claims process, the full-time remote Claims Auditor will investigate claims liability, process claims according to policies, and communicate with third-party administrators to resolve issues.

Key Responsibilities:

• Review and interpret employer health coverage plans and excess insurance policies for individual claims
• Audit submitted claim documents for accuracy and verify that benefits were paid correctly
• Set and adjust claims reserves, and authorize checks for liability amounts while communicating discrepancies to clients

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 to manage multiple tasks simultaneously
• Intermediate proficiency in Microsoft Office applications (Excel, Access, PowerPoint, Word)
• Knowledge of industry changes and legal updates related to the insurance sector