Claims Auditor - Remote

Job Summary

Working remotely in a full-time capacity, the Specific Claims Auditor will investigate claims liability, process claims according to policies, and communicate with clients 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 determine liability based on appropriate plans and policies
• Communicate with third-party administrators and clients to resolve claim processing issues and authorize liability payments

Required Qualifications

• Strong medical knowledge, including ICD, CPT, medical terminology, COBRA, and HIPAA
• Ability to read and interpret documents such as benefit plans 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)
• Knowledgeable about industry changes and legal updates relevant to the insurance business