Specific Claims Auditor

September 15

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Tokio Marine HCC

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Accident & Health • Aviation • Directors & Officers • Property & Casualty • Surety & Credit

1001 - 5000

Description

• Investigates claims liability and determine the extent of liability on submitted claim • Accurately processes the claim according to the policies or contracts • Establishes reserves for claim liability • Reviews and interprets employer plans of health coverage and excess insurance policy • Audits submitted claim documents for sufficient data and verifies that benefits were paid correctly • Communicates with third-party administrator (TPA)/client to resolve claim processing issues • Sets claims reserves and adjusts as needed • Keeps the reserves current • Authorizes checks for amount of liability and communicates to TPA/client • Refers large-dollar claims to preliminary claims and case management departments • Follows 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 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)

Benefits

• 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