Senior Claims Auditor

Tokio Marine HCC

Investigating claims liability and processing claims for Tokio Marine HCC. Ensuring compliance with health coverage policies within departmental standards.

Posted 7/29/2026full-timeRemote • Minnesota • 🇺🇸 United StatesSenior💰 $56,600 - $125,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong medical knowledge, including proficiency in ICD, CPT, and medical terminology, while effectively managing claims liability and processing. Exhibits exceptional organizational, analytical, and communication skills to handle complex claims and maintain compliance with industry standards.

Highest-signal resume keywords

Medical KnowledgeClaims ProcessingAnalytical SkillsCommunication SkillsMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

International Classification of Diseases (ICD)Current Procedural Terminology (CPT)Medical TerminologyClaims Liability AssessmentClaims AuditingReserve ManagementCost ContainmentPlan of Benefits InterpretationData VerificationRegulatory Compliance

Soft Skills

Written CommunicationVerbal CommunicationOrganizational SkillsAnalytical ThinkingTact and Diplomacy

Tools & Technologies

Microsoft ExcelMicrosoft AccessMicrosoft PowerPointMicrosoft Word

Industry Keywords

COBRAHIPAAHealth Coverage PlansClaims ManagementInsurance Policies

About the role

Key responsibilities & impact

Investigates claims liability and determines the extent of liability on a submitted claim for a specific individual
Accurately processes the claim according to the policies or contracts that exist, within the departmental time frames and standards, and establishes reserves for claim liability
Review and interpret employer plans of health coverage and excess insurance policy to individual claims
Audit submitted claim documents for sufficient data, verify that benefits were paid correctly and in accordance with appropriate plans and policies, and determine liability
Ability to complete claim review with minimal questions to supervisors
Able to communicate with external and internal customers in a professional and clear manner
Monitoring the weekly reserve report consistently
Monitoring the weekly pend report for timely follow up and accuracy
Determine, set, monitor reserves to maintain that reserves are appropriate
Authorize checks for amount of liability and communicate to Claims Administrator/client reasons for any amounts not covered by excess policy
Refer claims for cost containment to preliminary claims and specialty claims
Ability to audit complex claims and handle complex processes
Will be assigned more claims than an auditor, as needed

Requirements

What you’ll need

Strong medical knowledge including International Classification of Diseases (ICD), Current Procedural Terminology (CPT), medical terminology, COBRA, and HIPPA
Ability to read and interpret documents such as Plan of Benefits, claim reports, and procedural manuals
Possess and have ability to apply broad knowledge of principles, practices, and procedures
Excellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacy
Exceptional organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company’s business to proactively respond to changing business environment
Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)

Benefits

Comp & perks

Comprehensive medical, vision, and dental coverage, with eligibility beginning on your first day of employment
Basic life and disability insurance
401(k) plan with 6% company match
20 days of PTO, two floating holidays, approximately 11 paid holidays, and volunteer time off
Paid parental leave
Access to our award-winning wellness program, including mental health services, fitness network membership, and a complimentary Headspace subscription
Student loan matching program
Employee discount program