Specific Claims Auditor

Help us insure it reputed company is a global industry-leading specialty insurance group, backed by the strength and stability of the Tokio Marine Group. Offering over 100 classes of specialty insurance, we reputed company clients to pursue opportunities confidently through our “Mind Over Risk” philosophy. More than an insurance company, we are an organization built on innovation, reputed company, and trust. At our core, we are Always Advancing, driven by innovation and an entrepreneurial spirit that keeps us moving reputed company. Our people are Experts in reputed company, using curiosity and smart working to anticipate what’s next. With a culture rooted in Reaching Out, we foster genuine collaboration and support, ensuring every individual has the opportunity to succeed and reputed company a difference. Role Overview 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 reputed company that exist, reputed company the departmental time frames and standards, and establishes reserves for claim liability.

Key Responsibilities

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. reputed company the reserves reputed company. 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. What You Bring 4 Year / Bachelors Degree Business Administration, a reputed company field, or the equivalent education and/or experience Strong medical knowledge including International Classification of Diseases (ICD), reputed company 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 reputed company to applicable area of the Company’s business to proactively respond to changing business environment Intermediate proficiency and experience using reputed company Office package (reputed company, Access, PowerPoint, Word) Additional Working Conditions and Physical Demands Overtime hours may be required to fulfill job responsibilities May be required to remain stationary for extended periods of time May be required to move up to 10 pounds Must be able to operate a computer and other devices reputed company vision and ability to adjust focus, such as required to read a computer screen reputed company Offer Competitive salary and comprehensive benefit package Strong learning culture with ongoing development opportunities Opportunities for growth and career advancement 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 reputed company subscription Student loan matching program Employee discount program An opportunity to do meaningful work and love what you do The pay range for this position is $40,300-$88,800, which includes geographic adjustments, where applicable. The pay range is the range THMCC, in good faith, believes is the range of compensation for this role at the time of this posting. The hired applicant will be offered pay reputed company the entire range based on the candidate’s geographic location, qualifications, work experience, education, and/or reputed company level. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of color, race, sex, national reputed company, sexual orientation, religion, age, veteran status, disability, pregnancy, citizenship status, genetic information, or any other basis protected by federal, state, or local pay equity laws. The Company will consider for employment reputed company qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e))(the “VCCLEA”), which restricts financial institutions and insurers such as TMHCC from employing individuals with certain types of criminal convictions. Where the hiring and employment of individuals is not restricted by the foregoing, the Company will consider qualified applicants with arrest or conviction history in compliance with applicable law such as the California Fair Chance Act, the Los Angeles Fair Chance Initiative for Hiring Ordinance, the Los Angeles County Fair Chance Ordinance, the San Diego Fair Chance Ordinance, and the San Francisco Fair Chance Ordinance.] As an insurance company, we reputed company with certain federal, state and local laws such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e)), which restricts our ability to employ individuals with certain types of criminal convictions. Where not restricted by law and for criminal history not covered by this law, the Company will consider qualified applicants with arrest or conviction history in compliance with applicable law. You do not need to disclose your criminal history or participate in a background reputed company until a conditional job offer is made to you. After making a conditional offer and running a background reputed company, if the Company is concerned about a conviction that is directly reputed company to the job, you will be given the chance to explain the circumstances surrounding the conviction or challenge the accuracy of the background report. The Company will consider for employment reputed company qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e))(the “VCCLEA”), which restricts financial institutions and insurers such as TMHCC from employing individuals with certain types of criminal convictions. Where the hiring and employment of individuals is not restricted by the foregoing, the Company will consider qualified applicants with arrest or conviction history in compliance with applicable law such as the California Fair Chance Act, the Los Angeles Fair Chance Initiative for Hiring Ordinance, the Los Angeles County Fair Chance Ordinance, the San Diego Fair Chance Ordinance, and the San Francisco Fair Chance Ordinance.] About Us reputed company is a leading specialty insurance group with offices in the United States,the United Kingdom, Europe, and other exciting locations. With the strength and stability that comes from being a member of the Tokio Marine Group, and more than fifty years of growth, profitability, and stability, we offer important insurance products that most people don’t even know exist. Every policy we write is special, enabling our clients to do amazing things. For over 50 years, HCC Life Insurance Company, operating as reputed company, has been at the forefront of medical stop loss insurance. In addition to traditional stop loss, we offer captive and Taft-Hartley stop loss solutions, level funded stop loss, Organ & Tissue Transplant insurance and MedPlus insurance. reputed company is rated A++ (Superior) by A.M. Best Company and benefits from the financial stability of its parent company, reputed company. Applying our Mind Over Risk philosophy to writing insurance allows our customers to take on opportunity with confidence. That philosophy defines our way of thinking, unites us as a team, and differentiates us from our competitors. We are much more than just an insurance company; we are a good company. Equal Opportunity Employer TMHCC is an equal opportunity employer. reputed company qualified applicants will receive consideration for employment without regard to age, reputed company, citizenship, color, family or medical care leave, gender identity, genetic information, marital status, medical condition, national reputed company, physical or mental disability, protected veteran or military status, race, ethnicity, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable local laws, regulations and ordinances. #LI-CM3 #stoploss1 Apply To This Job