Health Claims Stop Loss Auditor

Role Overview

• Conducts detailed audits of high-complexity claims files to ensure compliance, accuracy, and adherence to company procedures and regulatory requirements.
• Perform in-depth claims file reviews for accuracy and compliance.
• Document findings and provide recommendations for corrective action.
• Identify trends and collaborate with departments to improve claim practices.
• Support audit reporting and analytics.

Requirements

• Bachelor's degree preferred; CPCU, AIC, or other insurance certifications a plus.
• 4
• 6 years of claims or audit experience.
• Strong understanding of claims handling and insurance regulations.
• Analytical, organized, and skilled in Excel/audit systems.

Benefits

• Health Claims Stop Loss
• Flexible work arrangements
• Professional development opportunities
• Equal opportunity workplace