Claims Auditor – Stop Loss, Aggregate

Skyward Specialty Insurance

Claims Auditor for validating medical stop loss aggregate claim reimbursements at Skyward Specialty. Ensuring accuracy and compliance through auditing claim data, eligibility, plan provisions, and contract terms.

Posted 7/15/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $65,000 - $85,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in auditing medical stop loss aggregate claims, ensuring accuracy in claim data, eligibility, and contract terms. Proficient in data analysis and reconciliation, with strong communication skills to resolve discrepancies with stakeholders.

Highest-signal resume keywords

Stop Loss Aggregate Claim HandlingAggregate Stop Loss ConceptsMedical Claims ComponentsEligibility/Enrollment ReconciliationProficiency With Excel

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claim Data AuditingReimbursement ValidationData ReconciliationContract InterpretationAnalytical Skills

Soft Skills

Attention To DetailCommunication Skills

Tools & Technologies

ExcelPivot TablesXLOOKUPVLOOKUPData Validation

Industry Keywords

Coordination Of BenefitsSubrogationThird-Party RecoveryProvider CreditsRx Rebates

About the role

Key responsibilities & impact

Review and validate medical stop loss aggregate claim reimbursements by auditing claim data, eligibility, plan provisions, and contract terms
Audit aggregate stop loss submissions (weekly/monthly/quarterly/annual) to confirm accuracy
Confirm appropriate treatment of: Coordination of Benefits (COB), subrogation, third-party recovery offsets, Provider credits/refunds, Rx rebates (if contractually relevant)
Reconcile eligibility/enrollment counts
Review Plan & Contract Interpret - Stop loss policy/certificate, endorsements, and amendments
Communicate with underwriting, TPA’s, brokers/producers to resolve discrepancies

Requirements

What you’ll need

2+ years of experience of Stop loss Aggregate claim handling
Working knowledge of: Aggregate stop loss concepts (attachment points, factors, contract basis, reimbursements), Medical claims components (allowed vs. paid, reversals/adjustments, claim timing), Eligibility/enrollment reconciliation
Funding verification
Strong analytical skills with attention to detail and ability to interpret plan/contract language
Proficiency with Excel (pivot tables, XLOOKUP/VLOOKUP, filtering, data validation; comfort with large datasets)

Benefits

Comp & perks

Health and welfare benefits
Tuition and professional certification assistance
401k savings
Elective participation in the Employee Stock Purchase Program
Paid time off
Paid holidays
Child bonding leave
Other employee assistance