Claims Auditor - Remote

Working remotely in a full-time capacity, the Specific Claims Auditor will investigate claims liability, process claims according to policies, and communicate with clients 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 determine liability based on appropriate plans and policies Communicate with third-party administrators and clients to resolve claim processing issues and authorize liability payments Required Qualifications Strong medical knowledge, including ICD, CPT, medical terminology, COBRA, and HIPAA Ability to read and interpret documents such as benefit plans and claim reports Advanced organizational and analytical skills with the ability to manage multiple tasks simultaneously Intermediate proficiency in Microsoft Office applications (Excel, Access, PowerPoint, Word) Knowledgeable about industry changes and legal updates relevant to the insurance business