Claims Quality Auditor jobs in New Jersey

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Summary of Role: 

Excess Reinsurance, a market leader in the self-funded medical insurance market, is seeking a full-time claims auditor to join our team. The Claims Auditor is responsible for auditing and authorizing reimbursements of specific medical stop loss claims. Candidates should have three years’ experience working in the medical insurance industry.

Responsibilities:

• Audit reimbursement requests of specific and aggregate stop loss medical claims submitted by Third Party Administrators
• Analyze stop loss claims and determine that they are payable in accordance with the plan document and excess loss policy
• Investigate medical process through reports and invoices for medical necessity of care
• Determine status of claims for reimbursement or denial
• Communicate effectively with outside contacts such as TPAs and brokers

Qualifications:

• Minimum three years’ experience as a medical claims’ examiner and/or Stop Loss claims auditor
• Knowledge of medical terminology and disease processes
• Good reasoning and analytical skills are essential
• Must be proficient in Microsoft products, especially Excel
• Must possess excellent verbal and written communications skills
• Ability to work independently and in a team environment

***For this opportunity, you will be required to attend the office 4x a week.***

Excess Reinsurance offers a competitive salary and benefits including medical, dental, and vision, 401(k), and paid time off.

Excess Reinsurance is located in Woodbury, NJ approximately 12 miles from Philadelphia.

What We Offer  

We're proud to offer a competitive salary, PTO & paid holidays, 401(k) with match, exclusive discount programs, health & wellness programs, and more. Our PeopleFirst culture focuses on building and nurturing lifelong relationships with our employees because, at the end of the day, we exist to be there for others.  

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NFP is an inclusive Equal Employment Opportunity employer.