Specific Claims Auditor

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $40.3k - $80.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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👻 Ghost score 0%

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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

• Investigate claims liability and determine the extent of liability on submitted individual claims • Accurately process claims according to applicable policies or contracts within departmental time frames and standards • Establish and maintain reserves for claim liability • Review and interpret employer health coverage plans and excess insurance policies for individual claims • Audit submitted claim documents for sufficient data • Verify that benefits were paid correctly and in accordance with applicable plans and policies • Communicate in writing and verbally with third-party administrators (TPAs) and clients to resolve claim processing issues • Set and adjust claims reserves as needed and keep reserves current • Authorize checks for amounts of liability • Communicate reasons for amounts not covered by the excess policy to TPAs/clients • Refer large-dollar claims and trigger diagnoses to preliminary claims and case management departments

🎯 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 • 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 • Knowledge of industry changes, legal updates, and technical developments related to the 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 • Company-provided long-term disability and life insurance • Opportunities for advancement • Flexible work schedules • Work/life balance • Paid Parental Leave • Volunteer Time Off • Casual dress • Modern, comfortable office with free parking