Claims Auditor
Responsibilities:
• Examine claim forms, supporting records, and benefit requests to determine coverage eligibility and decide whether claims should be approved, declined, or held pending additional documentation.
• Record claim activity, decisions, and supporting details in the claims administration system with a high degree of accuracy and completeness.
• Prepare written communication to claimants, beneficiaries, financial institutions, medical providers, attorneys, and internal partners to explain outcomes or request missing information.
• Assess medical documentation, application details, and policy exclusions to confirm whether coverage requirements were satisfied at issue and escalate questionable disclosures for legal review when appropriate.
• Validate beneficiary information on life claims to confirm that proceeds are directed to the correct eligible party.
• Review applicable state regulations during life claim processing, including required beneficiary verification checks related to child support compliance.
• Recognize indicators of suspicious activity, document concerns thoroughly, and refer potential fraud matters to the appropriate legal team.
• Respond to questions from sales partners, account contacts, and internal teams regarding claim status, benefit determinations, and related service issues.
• Monitor open items and follow through on pending claims to obtain outstanding records and keep cases moving toward resolution.
• Support departmental workflow by assisting with cross-coverage, special assignments, and collaboration across teams to resolve issues efficiently.
Qualifications:
• Associate degree in Business or a related field, or an equivalent combination of education and relevant experience.• At least five years of experience in claims auditing or claims review with increasing responsibility.
• Practical background in resolving customer or client service issues in a detail-oriented setting.
• Strong computer proficiency, including the ability to navigate multiple software applications and maintain accurate electronic records.
• Working knowledge of claims processing, claims data review, and insurance claim evaluation.
• Ability to safeguard confidential and sensitive information with discretion.
• Insurance coursework or industry designations are preferred.
• Previous exposure to credit insurance, life claims, or medical terminology is beneficial.
Compensation
$55,000.00-$60,000.00 YearlyAbout Us
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
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