Claims Auditor-2

Position Summary:
As a Claims Auditor-2, you will investigate claims liability and determine the extent of liability on submitted claims for specific individuals. You will accurately process claims according to policies or contracts within departmental time frames and standards, and establish reserves for claim liability.

Key Responsibilities:

1. Review and interpret employer plans of health coverage and excess insurance policy to individual claims
2. Audit submitted claim documents for sufficient data, verifying that benefits were paid correctly and in accordance with appropriate plans and policies, and determine liability
3. Communicate in writing and verbally with third-party administrators (TPAs) or clients, as needed, to resolve claim processing issues
4. Set claims reserves and adjust as needed. Keep the reserves current
5. Authorize checks for the amount of liability and communicate to TPA/client reasons for any amounts not covered by excess policy
6. Refer large-dollar claims and trigger diagnoses to preliminary claims and case management departments
7. Follow work plans, established timelines, and predefined goals for assigned work

Requirements:
Strong medical knowledge, including International Classification of Diseases (ICD), Current Procedural Terminology (CPT), medical terminology, COBRA, and HIPAA. Ability to read and interpret documents such as Plan of Benefits, claim reports, and procedural manuals. Possess and apply knowledge of principles, practices, and procedures. Solid written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy. Advanced organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously.

Benefits:
Tokio Marine offers a competitive salary and benefits package, including generous paid time off (PTO), 12 paid company holidays, 401(k) Retirement Plan with a 6% company match, health and dental insurance, vision plan available, company-provided long-term disability and life insurance, opportunities for advancement in a successful and growing organization, flexible work schedules, and a great work-life balance.

About Us:
Tokio Marine HCC is a successful and dynamic organization experiencing rapid growth. We are seeking energetic and confident individuals to join our team of professionals. As an equal-opportunity employer, we value diversity and inclusion. Please visit our website for more information about our companies.