Specific Claims Auditor

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

📋 Description

• Examine claims liability and assess the extent of liability for submitted individual claims.

• Process claims accurately in accordance with relevant policies or contracts within departmental timelines and standards.

• Create, establish, and maintain current claims reserves.

• Analyze and interpret employer health coverage plans and excess insurance policies for individual claims.

• Review claim documents for adequate data and confirm that benefits were disbursed correctly based on applicable plans and policies.

• Engage in written and verbal communication with third-party administrators (TPAs) and clients to address and resolve claim processing issues.

• Authorize checks for liability sums and explain reasons for amounts not covered by the excess policy.

• Direct large-dollar claims and trigger diagnoses to preliminary claims and case management departments.

⛳️ Requirements

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

• Proficiency in reading and interpreting documents such as Plans of Benefits, claim reports, and procedural manuals.

• Capability to apply knowledge of principles, practices, and procedures effectively.

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

• Advanced organizational and analytical abilities; proven capacity to manage multiple tasks simultaneously.

• Awareness of industry changes, legal updates, and technical developments pertinent to the relevant area of the Company’s business.

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

🏝️ Benefits

• Generous paid time off (PTO).

• 12 paid company holidays.

• 401(k) Retirement Plan with a 6% company match.

• Health and dental insurance.

• Vision plan.

• Company-provided long-term disability and life insurance.

• Opportunities for advancement within a successful and growing organization.

• Flexible work schedules.

• Emphasis on work/life balance.

• Paid Parental Leave.

• Volunteer Time Off.

• Casual dress code.

• Modern, comfortable office environment with free parking.