Claims Auditor

To support the claims process, the full-time remote Claims Auditor will investigate claims liability, process claims according to policies, and communicate with third-party administrators 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 verify that benefits were paid correctly Set and adjust claims reserves, and authorize checks for liability amounts while communicating discrepancies to clients Required Qualifications: Strong medical knowledge including ICD, CPT, medical terminology, COBRA, and HIPAA Ability to read and interpret documents such as Plan of Benefits and claim reports Advanced organizational and analytical skills to manage multiple tasks simultaneously Intermediate proficiency in Microsoft Office applications (Excel, Access, PowerPoint, Word) Knowledge of industry changes and legal updates related to the insurance sector