Job Closed

This listing is no longer active.

Cisco logo
Cisco

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

10 yrs expEnglish

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

Related Categories

Related Job Pages

More Auditor Jobs

Ensemble Health Partners logo

DRG Validation Coding Auditor

Ensemble Health Partners

Ensemble Health Partners is a hospital and healthcare company that partners with client hospitals to help them develop processes, train teams, reach their finan

Auditor164 days ago

• Perform documentation and coding audits for all acute inpatient services for clients • Identify coding errors, compliance, and educational opportunities • Optimize reimbursement by ensuring accurate codes and documentation • Conduct independent reviews and apply coding principles • Verify coding accuracy and clinical indicators • Maintain productivity and quality goals

United States
$69.4K / year
IT Coalition logo

Senior Auditor

IT Coalition

One Vision. One Mission. One Team.

Auditor169 days ago
Full TimeRemoteTeam 501-1,000Since 2006H1B No Sponsor

• Directs, provides guidance and advice, and reviews the work product of more junior Auditors and Financial Analysts to ensure that it meets the stated objectives of audit investigations. • Reports to the Trial Staff and COR as required on the status of audit investigations; prepares interim and final written reports and recommendations based on the results of audit investigations. • Reviews and analyzes financial and operating statements, records and other information in order to arrive at results and conclusions in accordance with the stated objectives of audit investigations.

Virginia
EXL logo

Elite Premium Insurance Filed Auditor

EXL

We make sense of data to drive your business forward. #MakeSenseofData #DriveYourBusinessForward #PartnerYourWay

Auditor170 days ago
OtherRemoteTeam 10,001+H1B No Sponsor

• Performing physical and remote audits of insured’s business • Interviews, investigates, collects, and records information to be used in a written report that is provided to the insurance carrier.

Florida
$60K - $90K / year
Job Closed
EXL logo

Premium Insurance Field Auditor

EXL

We make sense of data to drive your business forward. #MakeSenseofData #DriveYourBusinessForward #PartnerYourWay

Auditor170 days ago
OtherRemoteTeam 10,001+H1B No Sponsor

• Conduct insurance policy audits for Worker’s Compensation, Auto and General Liability policies. • Audit the policyholder’s records according to client company standards. • Schedule appointments with the insured to be audited and obtain necessary documentation for insurance company client audits.

New York
$40K - $60K / year