Claims Auditor

American Benefit Corporation

Ona (WV)

On-site

USD 60,000 - 85,000

Full time

14 days+

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Job summary

A company in the health benefits sector is seeking a Claims Auditor to join their team. This entry-level position requires strong organizational skills and the ability to manage claims accurately. Ideal candidates will have a high school diploma, familiarity with medical terminology, and a detail-oriented approach. Competitive salary is offered, with normal work hours from Monday to Friday, 8:30 AM to 5:00 PM.

Qualifications

Detail-oriented worker with strong organizational skills.
Ability to follow procedures and maintain confidentiality.
No previous experience required but related experience preferred.

Responsibilities

Examine claims and determine benefits according to plan provisions.
Correspond with providers and maintain accurate records.
Release checks and produce check registers as required.
File reinsurance claims for stop loss reimbursement.
Maintain up-to-date claim information.

Skills

Detail-oriented

Efficient work with minimal supervision

Microsoft Office programs

Excellent communication skills

Fast learner

Well organized

Familiarity with medical terminology

Ability to multi-task

Education

High School Diploma

Bachelor’s Degree (preferred)

Job description

American Benefit Corporation is looking to add a detail-oriented, master multi-tasker to our team! If your organizational skills are on point, you’re comfortable working with deadlines, and you are interested in growing your career in the health and benefits service industry, this job is a perfect fit for you.

Position:

Claims Auditor

Designation:

Hourly Non-Exempt, Union

Position Summary

American Benefit Corporation, a Third-Party Administrator of employee benefits and retirement funds, is looking to hire a Claims Auditor. This position would be ideal for recent graduates majoring in Health Science, Health Informatics, Exercise Science, and related fields. A great transition for anyone with work experience in medical or dental coding. Candidates must be self‑starters, adept multi‑taskers, and capable of meeting strict deadlines.

Job Duties

Examine claims and determine benefits in accordance with the plan provisions.
Correspond with providers and participants, keeping accurate records of conversations and outcomes.
Follow through regarding problems or requests resulting from phone inquiries in accordance with policies and procedures.
Release checks and produce check registers as required.
Provide claim totals to appropriate parties for bank transfers as needed.
Maintain up‑to‑date claim information in group binders.
File reinsurance claims for stop loss reimbursement.
Test new groups or new benefits, which have been entered into the claims adjudication system for accuracy.
Meet deadlines and adhere to schedules as required by position.
Retrieve and file records, including records in storage as required.
Maintain confidentiality during and post‑employment.
Reports to the job as scheduled.
All other duties as assigned.

Necessary Skills

Must be a detail‑oriented worker.
Must work efficiently and accurately with minimal supervision.
Knowledge of all Microsoft Office programs.
Excellent communication skills, punctuality, and attendance.
Must be a fast learner.
Must be well organized.
Ability to follow departmental and company procedures.
Familiarity with medical terminology, including anatomy.
Ability to multi‑task and concentrate in a large office environment.
Ability to organize and prioritize job responsibilities.

Education & Experience

High School Diploma (or equivalent) is required; Bachelor’s Degree in related field is preferred.
No prior experience is required, but 1-2 years of related experience is preferred.

Physical Requirements

The majority of this position will be completed in a stationary position; however, the person in this position needs to occasionally move about inside an office setting and across our ABC Campus.

Regularly operate a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer.

The person in this position must be able to regularly communicate accurate information.

Travel and Work Hours Requirements

This position rarely requires travel.

Usual work hours are standard Monday – Friday, 8:30 am to 5:00 pm.

Equal Opportunity Employer

American Benefit Corporation is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

We do not discriminate in employment on the basis of race, color, religion, sex, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, parental status, military service, or other non‑merit factor.

Seniority level