Claims Auditor

🕒 2 days ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 determines the extent of liability on a submitted claim • Accurately processes the claim according to the policies or contracts that exist • 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 • Communicates with third-party administrator/client to resolve claim processing issues • Sets claims reserves and adjusts as needed • Authorizes checks for amount of liability and communicates to TPA/client reasons for any amounts not covered • Refers large-dollar claims to preliminary claims and case management departments

🎯 Requirements

• Strong medical knowledge including ICD, CPT, medical terminology, COBRA, and HIPAA • 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 • 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 • Flexible work schedules • Great work/life balance • Paid Parental Leave • Volunteer Time Off • Casual dress and modern office with free parking