Health Claims Auditor

Job Summary

Conducting detailed audits of high-complexity claims files, the full-time Health Claims Stop Loss Auditor will ensure compliance, accuracy, and adherence to company procedures and regulatory requirements in a remote setting.

Key responsibilities

• Perform in-depth claims file reviews for accuracy and compliance
• Document findings and provide recommendations for corrective action
• Identify trends and collaborate with departments to improve claim practices

Required qualifications

• Bachelor's degree preferred; CPCU, AIC, or other insurance certifications a plus
• 4 - 6 years of claims or audit experience
• Strong understanding of claims handling and insurance regulations
• Analytical, organized, and skilled in Excel/audit systems