Aggregate Claims Auditor

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $50.5k - $111.5k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 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

• Under supervision, investigates claims liability and determines the extent of liability on submitted claims for an overall contract that is approaching or exceeds the aggregate attachment point • Accurately processes the claim according to the policies or contracts that exist, within the departmental time frames and standards, and establishes reserves for claim liability • Review and interpret employer plans of health coverage and excess insurance policy • Audit monthly and year-end aggregate claims for payment from receipt through completion • Follow-up on missing documentation when necessary • Interpret paid claims reports, eligibility reports, funding documentation, check registers, prescription reports to verify contract/plan document is being followed correctly • Communicates 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 • Interpret contract/plan document and determine appropriate reimbursement • Also determine any out-of-contract items/amounts • Obtain refunds from TPA when year-end results indicate monthly accommodations were too large • Maintain quality, quantity, and turnaround time standards of company • Review the TPA/client operations to verify in guidelines of contract/plan documents

🎯 Requirements

• 4 Year / Bachelors Degree Business Administration or a related field or the equivalent education and/or experience • 2 Years relevant and progressive professional experience in auditing and claims • Possess and have ability to apply broad knowledge of principles, practices, and procedures • Strong medical knowledge including ICD10, CPT, medical terminology, COBRA, and HIPPA • Ability to read and interpret documents such as Plan of benefits, claim reports, and procedural manuals • 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

🏖️ 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 • Opportunities for growth and career advancement