Senior Claims Auditor

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🔥 4 minutes ago

❄️ Minnesota – Remote

❄️ Minnesota – Remote

💵 $56.6k - $125k / year

⏰ Full Time

🟠 Senior

🔎 Auditor

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Tokio Marine HCC

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

📦 Logistics

💼 Consulting

✈️ Travel

Logistics • Consulting • Travel

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 for a specific individual • 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 to individual claims • Audit submitted claim documents for sufficient data, verify that benefits were paid correctly and in accordance with appropriate plans and policies, and determine liability • Ability to complete claim review with minimal questions to supervisors • Able to communicate with external and internal customers in a professional and clear manner • Monitoring the weekly reserve report consistently • Monitoring the weekly pend report for timely follow up and accuracy • Determine, set, monitor reserves to maintain that reserves are appropriate • Authorize checks for amount of liability and communicate to Claims Administrator/client reasons for any amounts not covered by excess policy • Refer claims for cost containment to preliminary claims and specialty claims • Ability to audit complex claims and handle complex processes • Will be assigned more claims than an auditor, as needed

🎯 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 broad knowledge of principles, practices, and procedures • Excellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacy • Exceptional 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