Accident and Health Claims Auditor

One80 Intermediaries • Clearwater, FL

7d • $20 - $22

About The Position

One80 Intermediaries is seeking an Accident and Health Claims Auditor to review and analyze claims to ensure they are processed accurately and in accordance with policy provisions. The role handles moderate to complex claim issues, obtains necessary documentation, and determines whether claims should be approved or denied based on established guidelines. The auditor also releases accurate benefit payments in accordance with CBP policy, industry standards, and applicable TPA or SLA agreements, and may receive inbound calls in assigned queues or as overflow for the CSR team.

Requirements

• High school diploma or equivalent.
• Ability to function independently within established guidelines.
• Excellent interpersonal, oral, and written communication skills.
• Intermediate skill level in Microsoft Office programs.

Responsibilities

• Analyze and research claim issues of moderate to complex difficulty.
• Review and apply policy provisions when processing claims.
• Request and obtain necessary documents for claim processing or consideration, including scheduling follow-ups for documentation.
• Release accurate benefit payments in accordance with CBP policy, industry standards, and applicable TPA or SLA agreements.
• Document required information in the claim system, including follow-up information.
• Receive inbound calls within assigned queues and/or as overflow for the CSR team.
• Comprehend complicated workflows, policy certificates, and policy provisions.

Benefits

• Medical/Rx, dental, vision, life, and disability insurance.
• Employee stock purchase plan (ESPP).
• 401(k).
• Student loan assistance.
• Tuition reimbursement.
• Free mental health and enhanced advocacy services.
• Paid time off and holidays.
• Preferred partner discounts.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED