Specific Claims Auditor

🕒 June 20

🇺🇸 United States – Remote

💵 $40.3k - $88.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Tokio Marine HCC

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🤝 B2B

💸 Finance

B2B • Finance

Tokio Marine HCC is a global specialty insurance and reinsurance group that underwrites more than 100 classes of specialty insurance across 180+ countries. The company offers a wide range of commercial products—including accident & health, aviation, casualty, cyber & tech, energy, marine, travel, crop, and transactional risk—serving brokers, enterprises, and program partners. With strong financial ratings (AM Best A++ / Fitch AA- / S&P A+) and a multi-billion dollar premium base, Tokio Marine HCC combines underwriting expertise, program management, and claims services as part of the Tokio Marine Group.

📋 Description

• Investigates claims liability and determine the extent of liability on a submitted claim for a specific individual • Accurately processes the claim according to the policies or contracts that exist, within the departmental time frames and standards • Establishes reserves for claim liability • Reviews and interprets employer plans of health coverage and excess insurance policy to individual claims • Audits submitted claim documents for sufficient data, verifying that benefits were paid correctly and in accordance with appropriate plans and policies • Communicates in writing and verbally with third-party administrator (TPA)/client, as needed, 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 reasons for any amounts not covered by excess policy • Refers large-dollar claims and trigger diagnosis to preliminary claims and case management departments

🎯 Requirements

• 4 Year / Bachelors Degree Business Administration, a related field, or the equivalent education and/or experience • 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

• Comprehensive medical, vision, and dental coverage, with eligibility beginning on your first day of employment • Basic life and disability insurance • 401(k) plan with 6% company match • 20 days of PTO, two floating holidays, approximately 11 paid holidays, and volunteer time off • Paid parental leave • Access to our award-winning wellness program, including mental health services, fitness network membership, and a complimentary Headspace subscription • Student loan matching program • Employee discount program