Specific Claims Auditor

🕒 2 days ago

🇺🇸 United States – Remote

💵 $40.3k - $80.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 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 determine 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, verifying that benefits were paid correctly and in accordance with appropriate plans and policies, and determine liability. • Communicate 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. • Authorize checks for amount of liability and communicate to TPA/client reasons for any amounts not covered by excess policy. • Refer large-dollar claims and trigger diagnosis 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 • 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 to proactively respond to changing business environment • 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 in a successful and growing organization. • Flexible work schedules and a great work/life balance. • Paid Parental Leave. • Volunteer Time Off. • Enjoy casual dress and work in a modern, comfortable office with free parking.