Seasonal Senior Claims Auditor/Consultant

Job not on LinkedIn

🔥 12 hours ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $65 / hour

⏱ Part Time

🟠 Senior

🔎 Auditor

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Brown & Brown Insurance

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1939

💸 Finance

🛡️ Insurance

Finance • Insurance

Brown & Brown Insurance is one of the largest independent insurance brokerages globally, providing a comprehensive range of risk management solutions. Established in 1939, the company offers personal and business insurance, employee benefits, and various national programs. Brown & Brown is committed to diversity, inclusion, and belonging, fostering a culture that values talent and experience. With over 500 locations, the company is well-positioned to meet the diverse needs of its clientele and is listed on the New York Stock Exchange under the ticker BRO. The firm's strategic focus on mergers and acquisitions highlights its disciplined growth strategy.

📋 Description

• Manage and adjudicate a portfolio of complex Employer Stop Loss claims within established authority levels and in accordance with policy and contract provisions. • Review and interpret Stop Loss policies, certificates, plan documents, eligibility provisions, deductibles, exclusions, reimbursement provisions, and other contractual terms to determine claim eligibility and reimbursement. • Conduct comprehensive reviews of high-dollar, complex, and unusual claims, including significant medical expenses, transplant, oncology, catastrophic conditions, specialty drugs, and other high-cost services. • Analyze claims data, medical records, eligibility information, provider documentation, invoices, and supporting documentation to validate claim accuracy and reimbursement. • Review claims for appropriate adjudication, including eligibility, deductibles, exclusions, benefits, payment calculations, and application of policy terms. • Manage large-loss claims and provide reporting, analysis, recommendations, and escalation to the Vice President of Claims and other stakeholders. • Review and recommend reserves for large and complex claims based on available information, anticipated claim liability, policy provisions, and reserving guidelines. • Monitor large claims throughout their lifecycle and update reserves, claim estimates, and management reports. • Conduct pre- and post-payment claim audits to identify payment inaccuracies, processing errors, documentation deficiencies, and opportunities for recovery or correction. • Identify trends, recurring errors, system issues, and process deficiencies affecting claim accuracy or financial performance and recommend corrective action. • Work with TPAs and external claims administrators to resolve complex claims issues, validate claim information, and ensure contractual and administrative compliance. • Manage inquiries and escalated claim matters from brokers, TPAs, plan sponsors, Underwriting, reinsurers, and other stakeholders.

🎯 Requirements

• Bachelor's degree required. • Minimum of seven (7) years of progressive experience in claims, with significant experience in Employer Stop Loss, medical claims, health benefits, or a related insurance environment. • Demonstrated experience handling complex and high-dollar medical claims. • Experience with claims auditing, adjudication, payment review, and claims analysis. • Experience interpreting insurance contracts, plan documents, and claims provisions. • Experience managing large-loss claims and making reserve recommendations.

🏖️ Benefits

• Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance • Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement • Free Mental Health & Enhanced Advocacy Services • Paid Time Off • Holidays • Preferred Partner Discounts