Claims Auditor - Medical Stop Loss (specific)

Skyward Specialty Insurance

Kennesaw, Georgia, United States
Base: $60,000 - $90,000; bonus/equity: performance...
Hybrid
3+ years medical claims auditing experience
Knowledge of icd-10 cpt hcpcs coding
Understanding of hipaa regulatory requirements
Skyward Specialty Insurance is seeking a detail-oriented Claims Auditor specializing in Medical Stop Loss to ensure the accuracy and compliance of accident and health insurance claims. The ideal candidate should have robust experience in claims auditing and processing, alongside strong analytical skills and knowledge of regulatory requirements

Job Summary

  • The Senior Auditor will conduct thorough audits of accident and health insurance claims to verify accuracy and policy compliance.
  • This role requires maintaining strict adherence to industry regulations including HIPAA while identifying opportunities for process improvement.
  • The company offers a competitive total rewards package including health benefits, tuition assistance, and a 401k savings plan.

Matching Summary

Match Score: 85

Skyward Specialty Insurance is seeking a detail-oriented Claims Auditor specializing in Medical Stop Loss to ensure the accuracy and compliance of accident and health insurance claims. The ideal candidate should have robust experience in claims auditing and processing, alongside strong analytical skills and knowledge of regulatory requirements.

Salary

Base: $60,000 - $90,000; Bonus/Equity: Performance-based incentives eligible; Benefits: Health/welfare, 401k, PTO, child bonding leave

Skills & Requirements

Must-have

  • 3+ years medical claims auditing experience
  • Knowledge of ICD-10 CPT HCPCS coding
  • Understanding of HIPAA regulatory requirements
  • Proficiency in claims processing systems
  • Ability to interpret plan documents

Nice-to-have

  • Experience with Medicare COBRA FMLA guidelines
  • Strong analytical problem-solving skills
  • Mentorship and training capabilities
  • Collaborative team environment focus
  • Project management abilities

Key Requirements

  • Bachelor's degree in business or insurance preferred
  • Minimum 3 years in medical claims auditing
  • Robust knowledge of claims protocols and regulations

Work Rights

Not specified

Tailored Resume

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