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Cisco is a publicly-traded, award-winning global technology solutions firm. Established in 1984 by a group of Stanford University computer scientists, Cisco has
Senior Claim Auditor
Location
Florida + 3 moreAll locations: Florida | Kentucky | New Jersey | North Carolina
Posted
164 days ago
Salary
$80K - $106K / year
Seniority
Senior
Job Description
Senior Claim Auditor
Cisco
• Receive, log, and validate incoming stop-loss claims and related documentation • Verify eligibility, plan benefits, and stop-loss policy provisions • Accurately enter claim details into the system of record • Maintain electronic claim files for audit and compliance purposes • Review, analyze, and adjudicate high-dollar and complex medical stop-loss claims • Identify cost-containment opportunities and implement strategies with carriers and TPAs • Document audit findings and maintain accurate records in the system • Communicate effectively and respond timely to TPAs, brokers, policyholders, and internal teams • Offer guidance to clients on claims procedures and coverage issues • Ensure adherence to regulatory requirements, internal controls, and fraud prevention policies • Stay current on industry trends, regulations, and best practices • Identify opportunities to streamline claim intake and processing workflows • Train and mentor junior claims processors on best practices
Job Requirements
- Minimum 10 years in medical stop-loss claims processing or related health insurance claims roles
- Proficiency in medical coding (ICD-10, CPT, HCPCS)
- Advanced Excel skills
- Expertise with claims processing systems
- Strong understanding of stop-loss insurance, plan documents, and claims handling practices
Benefits
- Medical, dental, and vision coverage
- Wellness plans
- Parental leave
- Adoption assistance
- Tuition reimbursement
- Paid Time Off
- Paid holidays
- 401(k) plan with company match
- Employee stock purchase plan
- Commuter benefits
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