Senior Claims Auditor

This is a fully remote position, open to applicants in Minnesota.

📋 Description

• Conducts investigations into claims liability and assesses the extent of liability for each submitted claim concerning a specific individual.

• Processes claims accurately in accordance with existing policies or contracts, adhering to departmental timelines and standards while establishing reserves for claim liability.

• Reviews and interprets employer health coverage plans and excess insurance policies as they relate to individual claims.

• Audits submitted claim documents to ensure they contain sufficient data, verifies that benefits were paid correctly per the relevant plans and policies, and assesses liability.

• Capable of completing claim reviews with minimal inquiries directed to supervisors.

• Communicates effectively with both external and internal customers in a professional and clear manner.

• Consistently monitors the weekly reserve report.

• Regularly checks the weekly pend report to ensure timely follow-up and accuracy.

• Determines, sets, and monitors reserves to ensure appropriateness.

• Authorizes checks for liability amounts and communicates with the Claims Administrator or client regarding any uncovered amounts by the excess policy.

• Refers claims for cost containment to preliminary and specialty claims.

• Capable of auditing complex claims and managing intricate processes.

• May be assigned a higher volume of claims than an auditor as necessary.

⛳️ Requirements

• Strong medical knowledge, including International Classification of Diseases (ICD), Current Procedural Terminology (CPT), medical terminology, COBRA, and HIPAA.

• Ability to read and interpret documents such as Plans of Benefits, claim reports, and procedural manuals.

• Possesses and can apply a broad understanding of principles, practices, and procedures.

• Excellent written and verbal communication skills with a focus on confidentiality, tact, and diplomacy.

• Exceptional organizational and analytical abilities; demonstrated capacity to manage multiple tasks concurrently.

• Informed about industry changes, legal updates, and technical advancements related to the applicable areas of the Company’s operations to proactively address a shifting business landscape.

• Intermediate proficiency and experience with the Microsoft Office Suite (Excel, Access, PowerPoint, Word).

🏝️ Benefits

• Comprehensive medical, vision, and dental coverage, with eligibility commencing on your first day of employment.

• Basic life and disability insurance.

• 401(k) plan featuring a 6% company match.

• 20 days of PTO, two floating holidays, approximately 11 paid holidays, and volunteer time off.

• Paid parental leave.

• Access to our award-winning wellness program, which includes mental health services, fitness network memberships, and a complimentary Headspace subscription.

• Student loan matching program.

• Employee discount program.