Health Claims Stop Loss Auditor
Based in United StatesFull-TimeMiddle
Salary51,800 - 75,000 USD per year
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Job Details
- Experience
- 4–6 years of experience
- Required Skills
- Microsoft ExcelCompliance
Requirements
- Bachelor’s degree preferred or equivalent professional experience in insurance or claims auditing
- 4–6 years of experience in claims handling, auditing, or health insurance operations
- Strong understanding of health insurance claims processes, stop-loss coverage, and regulatory requirements
- Experience working with insurance compliance frameworks and audit methodologies
- Strong analytical and critical thinking skills with high attention to detail
- Proficiency in Excel and audit or claims management systems
- Strong organizational skills with the ability to manage multiple complex files simultaneously
- Excellent written and verbal communication skills for reporting audit findings and recommendations
Responsibilities
- Conduct comprehensive audits of high-complexity health and stop-loss claims to ensure accuracy, compliance, and adherence to established guidelines
- Review claim documentation in detail to identify errors, inconsistencies, and potential compliance risks
- Document audit findings clearly and provide actionable recommendations for process improvement and corrective actions
- Analyze claims data to identify trends, patterns, and systemic issues impacting claims performance
- Support reporting activities by preparing audit summaries, metrics, and compliance documentation
- Collaborate with claims, risk, and operational teams to improve claim handling processes and reduce errors
- Ensure alignment with regulatory requirements, internal policies, and industry standards in all audit activities
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