Claims Auditor
1 week ago
Kennesaw, Georgia, United States
Tokio Marine HCC
Full time
Job SummaryWe are seeking a skilled Claims Auditor to join our team at Tokio Marine HCC. As a Claims Auditor, you will be responsible for investigating claims liability and determining the extent of liability on submitted claims for a specific individual.
Key Responsibilities- Review and interpret employer plans of health coverage and excess insurance policy to individual claims
- Audit submitted claim documents for sufficient data, verifying that benefits were paid correctly and in accordance with appropriate plans and policies, and determine liability
- Communicate in writing and verbally with third-party administrator (TPA)/client, as needed, to resolve claim processing issues
- Set claims reserves and adjusts as needed. Keep the reserves current
- Authorize checks for amount of liability and communicate to TPA/client reasons for any amounts not covered by excess policy
- Refer large-dollar claims and trigger diagnosis to preliminary claims and case management departments
- Follow work plans, established timelines, and predefined goals for assigned work
- Strong medical knowledge including International Classification of Diseases (ICD), Current Procedural Terminology (CPT), medical terminology, COBRA, and HIPPA
- Ability to read and interpret documents such as Plan of Benefits, claim reports, and procedural manuals
- Possess and have ability to 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
- Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environment
- Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)
- Competitive salary and benefits package
- Generous paid time off (PTO), 12 paid company holidays
- 401(k) Retirement Plan with 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
- Paid Parental Leave
- Volunteer Time Off
- Enjoy casual dress and work in a modern, comfortable office with free parking
- Hybrid work schedule
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Claims Auditor Specialist
2 days ago
Kennesaw, Georgia, United States Tokio Marine HCC Full timeJob Title: Claims Auditor SpecialistTokio Marine HCC is a leading provider of specialty insurance solutions, and we are seeking a skilled Claims Auditor Specialist to join our team.Job Summary:The Claims Auditor Specialist will be responsible for investigating claims liability and determining the extent of liability on submitted claims for specific...