Specific Claims Auditor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Specific Claims Auditor based in United States.

This role is responsible for reviewing and auditing individual claims to determine liability accurately and efficiently.
You will interpret health coverage plans and excess insurance policies to validate claim payments and coverage decisions.
The position combines medical knowledge, analytical review, financial judgment, and careful documentation.
You will work with third-party administrators and clients to resolve claim-processing questions and ensure accurate outcomes.
The role also involves establishing and maintaining appropriate claims reserves and authorizing payments within policy limits.
You’ll collaborate with claims and case management teams on significant claims and specific diagnoses requiring additional attention.
This is an opportunity to contribute to a specialized insurance environment where accuracy, confidentiality, and sound judgment directly support quality claims management.