Senior Claim Auditor
Cisco
full-time
Posted on:
Location Type: Remote
Location: Remote • Florida, Kentucky, New Jersey, North Carolina • 🇺🇸 United States
Visit company websiteSalary
💰 $80,000 - $106,000 per year
Job Level
Senior
About the role
- Receive, log, and validate incoming stop-loss claims and related documentation
- Verify eligibility, plan benefits, and stop-loss policy provisions
- Accurately enter claim details into the system of record
- Maintain electronic claim files for audit and compliance purposes
- Review, analyze, and adjudicate high-dollar and complex medical stop-loss claims
- Identify cost-containment opportunities and implement strategies with carriers and TPAs
- Document audit findings and maintain accurate records in the system
- Communicate effectively and respond timely to TPAs, brokers, policyholders, and internal teams
- Offer guidance to clients on claims procedures and coverage issues
- Ensure adherence to regulatory requirements, internal controls, and fraud prevention policies
- Stay current on industry trends, regulations, and best practices
- Identify opportunities to streamline claim intake and processing workflows
- Train and mentor junior claims processors on best practices
Requirements
- Minimum 10 years in medical stop-loss claims processing or related health insurance claims roles
- Proficiency in medical coding (ICD-10, CPT, HCPCS)
- Advanced Excel skills
- Expertise with claims processing systems
- Strong understanding of stop-loss insurance, plan documents, and claims handling practices
Benefits
- Medical, dental, and vision coverage
- Wellness plans
- Parental leave
- Adoption assistance
- Tuition reimbursement
- Paid Time Off
- Paid holidays
- 401(k) plan with company match
- Employee stock purchase plan
- Commuter benefits
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical codingICD-10CPTHCPCSclaims processingExcelstop-loss insuranceclaims handling practices
Soft skills
communicationguidancementoringanalysisproblem-solving