Specific Claims Auditor

📋 Description

• Review and interpret employer health plans, excess insurance policies, claim reports, and related
• Audit submitted claim information for completeness and accuracy, verifying that benefits have been
• Investigate claim details and determine the extent of coverage and financial liability within
• Communicate with third-party administrators and clients by phone and in writing to clarify
• Establish claim reserves based on anticipated liability and adjust reserves as necessary to keep
• Authorize claim payments within the applicable liability limits and communicate the rationale for

🎯 Requirements

• Strong medical knowledge, including ICD, CPT, medical terminology, COBRA, HIPAA, and related
• Ability to read, interpret, and apply health plan documents, benefit provisions, claim reports
• Demonstrated understanding of claims administration principles, practices, procedures, and
• Strong analytical and organizational skills, with the ability to manage multiple claims
• Excellent written and verbal communication skills, with a professional approach to confidentiality
• Ability to exercise sound judgment when reviewing claim documentation, determining liability

🎁 Benefits

• Competitive salary range of $40,300–$80,800, with geographic adjustments where applicable.
• Remote work opportunity within the United States, including eligibility for remote work from
• Generous paid time off and 12 paid company holidays.
• 401(k) retirement plan with a 6% company match.
• Health and dental insurance, plus vision coverage.
• Company-provided long-term disability and life insurance.