Claims Auditor Sr

We are looking for a Senior Claims Auditor to join our team. Senior Claims Auditor will focus on claims adjudication of Employer Stop Loss claims. This position exists to ensure the integrity of outside medical payments for the organization through verification of the accuracy of data-entered information and by auditing service-related information and invoice adjudication/payment for compliance with contract terms and policy and procedures. The auditor must be thoroughly familiar with outside medical systems and claims processing/adjudication processes. The Auditor must independently perform comprehensive audits of claims to source documents and identify inaccuracies. Conduct quality audits of claims, pre and post payments, and utilizing appropriate sources of information, including eligibility, enrollment, provider contracts, policy, and procedures.

Your Impact:

• Process employer stop loss claims within defined authority limits
• Handle customer service calls and correspondence from Brokers and TPAs. Lead and perform operational and financial audits of claims pre and post payment utilizing applicable source documents
• Performs individual claims audits to ensure accuracy of claims processed
• Handling of Complex Claims / Large Losses with direct reporting and coordination with Vice President of Claims to ensure the optimal outcome
• Provide claims handling instructions on a portfolio of large losses and associated litigation

Successful Candidate Will Have:

• 5-8 years of combined audit/claims experience
• Expertise in medical terminology and coding
• Advanced organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
• Proficient in Microsoft Office software
• Knowledge of David Young system preferred

About One80:

One80 Intermediaries is a privately held firm with offices throughout the US and Canada.  As a leading insurance wholesaler and program manager, One80 offers placement services and binding authority for property and casualty, life, travel/accident and health, affinity and administrative services, and warranty business.  Launched just four years ago, One80 Intermediaries has grown to be one of the largest intermediaries in the United States. In 2022, Business Insurance ranked One80 as the 5th Largest MGA/Underwriting Manager/Lloyd’s Coverholder, and 5th Largest Underwriting Manager in the country.

Located in Media, PA and established in 2007, Vista, a subsidiary of One80 is a full-service Managing General Underwriter of Medical Stop Loss Insurance. We have full in-house binding authority to manage stop loss insurance across the United States on behalf of our leading carriers and reinsurers. Backed by a team of experienced professionals we provide best-in-class products and services to our partners and clients.

One80 Intermediaries is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics.

Learn more about working at One80 Intermediaries by visiting our careers page: www.one80.com/careers.