Aggregate Claims Auditor [Remote]

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Aggregate Claims Auditor based in United States.

This role offers an opportunity to support accurate and efficient claims management within a specialized insurance environment. As an Aggregate Claims Auditor, you will review complex health plan claims, evaluate contract compliance, and determine appropriate liability and reimbursement decisions. You will play a key role in protecting financial accuracy by auditing claims approaching aggregate attachment points and maintaining accurate reserves. Working remotely, you will collaborate with clients and third-party administrators to resolve discrepancies and ensure adherence to policy requirements. The position combines analytical expertise, healthcare knowledge, and attention to detail to deliver high-quality claims outcomes. This is an ideal opportunity for professionals who enjoy investigative work, problem-solving, and contributing to reliable insurance operations.

Accountabilities

• Investigate claims liability and determine the appropriate level of responsibility for submitted claims under aggregate insurance contracts.
• Review and interpret employer health plans, excess insurance policies, and contract documentation to ensure accurate claims processing.
• Audit monthly and year-end aggregate claims from initial review through final completion, following established quality and turnaround standards.
• Analyze claims reports, eligibility records, funding documentation, check registers, prescription reports, and related data to verify compliance with plan requirements.
• Communicate with third-party administrators (TPAs) and clients to resolve claim processing issues, obtain missing documentation, and clarify discrepancies.
• Establish, maintain, and adjust claims reserves based on current liability assessments and contract obligations.
• Determine appropriate reimbursement amounts, including identification of non-covered or out-of-contract expenses.
• Coordinate recovery efforts and obtain refunds when overpayments or excessive monthly accommodations are identified.
• Review operational processes of TPAs and clients to ensure alignment with contractual guidelines and internal standards.
• Maintain high standards of accuracy, confidentiality, productivity, and customer service throughout the claims auditing process.

Requirements

• Bachelor’s degree in Business Administration, a related field, or equivalent combination of education and professional experience.
• Minimum of 2 years of relevant and progressive experience in claims auditing, insurance operations, healthcare claims, or a related field.
• Broad understanding of claims auditing principles, practices, procedures, and insurance operations.
• Strong medical knowledge, including ICD-10 codes, CPT codes, medical terminology, COBRA, and HIPAA requirements.
• Ability to interpret complex documents, including benefit plans, claims reports, contracts, and procedural manuals.
• Strong analytical and organizational skills with the ability to manage multiple priorities and meet deadlines.
• Excellent written and verbal communication skills with a focus on professionalism, confidentiality, tact, and diplomacy.
• Detail-oriented mindset with strong problem-solving abilities and the ability to identify discrepancies and recommend appropriate actions.

Benefits

• Competitive salary range of $50,500 to $111,500 , depending on geographic location, qualifications, experience, education, and skill level.
• Fully remote work opportunity within the United States.
• Comprehensive medical, dental, and vision insurance coverage beginning on the first day of employment.
• Basic life insurance and disability coverage.
• 401(k) retirement plan with a 6% company match.
• 20 days of paid time off, floating holidays, paid holidays, and volunteer time off.
• Paid parental leave.
• Access to wellness programs, mental health resources, fitness network memberships, and mindfulness tools.
• Student loan matching program.
• Employee discount programs.
• Opportunities for professional development, career growth, and continued learning.
• Opportunity to contribute to meaningful work within a specialized insurance environment.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.