Remote Claims Auditor – Health & Liability

Tokio Marine HCC; Georgia; On-site; USD 40,000 - 81,000; Full time

Benefits offered by this job

PTO

Holidays

401(k) retirement match

Health insurance

Dental insurance

Vision plan

Long-term disability

Life insurance

Career advancement

Flexible work schedules

Parental leave

Volunteer time off

Casual dress

Free parking

Remote Georgia option

Job summary

Tokio Marine HCC in the United States is seeking a claims liability investigator to assess liability on health and excess insurance claims under established policies. Under supervision, you will review plans, audit documents, set reserves, and communicate with TPAs and clients to resolve processing issues, while maintaining confidentiality and applying HIPAA guidelines.

Join a growing specialty-insurance group that emphasizes innovation, collaboration, and career advancement, with a

Qualifications

• Strong medical knowledge and clinical terminology.
• Ability to read and interpret Plan of Benefits and claim reports.
• Excellent written and verbal communication and confidentiality.
• Advanced organizational and analytical skills and multi-tasking.
• Proficient in Microsoft Office (Excel, Access, PowerPoint, Word).

Responsibilities

• Review employer health plans and determine liability for claims.
• Audit submitted claim documents for data sufficiency and correct benefits.
• Communicate with TPAs or clients to resolve processing issues.
• Set reserves and adjust as needed; keep reserves current.
• Authorize payments within policy limits and explain any denied amounts.
• Refer large-dollar claims to preliminary claims and case management.

Skills

Medical knowledge

Communication skills

Analytical skills

Organization

Tools

Microsoft Office

Excel

Access

PowerPoint

Word

Job description

Tokio Marine HCC in the United States is seeking a claims liability investigator to assess liability on health and excess insurance claims under established policies. Under supervision, you will review plans, audit documents, set reserves, and communicate with TPAs and clients to resolve processing issues, while maintaining confidentiality and applying HIPAA guidelines.

Join a growing specialty-insurance group that emphasizes innovation, collaboration, and career advancement, with a