Senior Claims Auditor (Employer Stop-Loss)

Senior Claims Auditor

We're seeking a detail-oriented and experienced Senior Claims Auditor to lead audits and ensure the integrity of Employer Stop Loss claim adjudication. In this role, you will perform in-depth audits of medical claims, ensuring compliance with policy, contracts, and internal procedures, both pre- and post-payment. Your work will play a critical role in maintaining payment accuracy and supporting our commitment to operational excellence.

Your Impact:

• Lead comprehensive audits of Employer Stop Loss claims to ensure accuracy in adjudication and compliance with policy, contract terms, and regulatory standards
• Independently investigate and resolve discrepancies, tracing inaccuracies to their source and recommending corrective actions to management
• Manage complex and high-dollar claims, including large loss cases over $100,000, coordinating with internal stakeholders and contributing to reserve strategy and litigation oversight
• Process claims and respond to inquiries from brokers and TPAs, delivering clear communication and maintaining a high standard of customer service
• Support team development by delivering technical training, sharing auditing best practices, and assisting colleagues with policy and procedural understanding
• Collaborate cross-functionally with underwriting, reinsurers, external vendors, and senior leadership to ensure optimal claims outcomes and continuous process improvement

Successful Candidate Will Have:

• BA/BS degree in related field preferred
• 10 years of combined audit/claims experience
• Proficient in Microsoft Office software
• Knowledge of David Young system preferred
• Expertise in medical terminology and coding

One80 Intermediaries is a privately held firm with offices throughout the US and Canada. As a leading insurance wholesaler and program manager, One80 offers placement services and binding authority for property and casualty, life, travel/accident and health, affinity and administrative services, and warranty business. Launched just four years ago, One80 Intermediaries has grown to be one of the largest intermediaries in the United States. In 2024, One80 Intermediaries was ranked the 14th largest broker in the U.S. by Business Insurance. In 2025, One80 Intermediaries earned the Great Place To Work Certification for the second consecutive year.

Located in Newtown Square, PA and established in 2007, the Medical Stop Loss program of One80 is a full-service Managing General Underwriter. We have full in-house binding authority to manage stop loss insurance across the United States on behalf of our leading carriers and reinsurers. Backed by a team of experienced professionals we provide best-in-class products and services to our partners and clients.

One80 Intermediaries is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics.

Learn more about working at One80 Intermediaries by visiting our careers page.

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