Great American Insurance Group · 4 weeks ago
Senior Specific Claim Auditor
United States
Full-time
Remote
Senior Level, Lead/Staff
$80K/yr - $106K/yr
10+ years expGreat American Insurance Group is a leader in the insurance industry, offering opportunities for growth and collaboration. The Senior Specific Claim Auditor is responsible for managing and validating stop-loss claims, ensuring compliance with regulatory standards, and providing guidance to clients on claims procedures.
FinanceFinancial ServicesInsurance
Responsibilities
Receive, log, and validate incoming stop-loss claims and related documentation; request missing information as needed
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; provide clear updates on claim status and documentation requirements
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; participate in special projects, reporting, and process improvement initiatives
Identify opportunities to streamline claim intake and processing workflows
Train and mentor junior claims processors on best practices
Perform other duties as assigned
Qualification
Required
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
Exceptional analytical ability
Attention to detail
Strong written and verbal communication skills
Benefits
Medical, dental, and vision coverage
Wellness plans
Parental leave
Adoption assistance
Tuition reimbursement
Paid Time Off
Paid holidays
A 401(k) plan with company match
An employee stock purchase plan
Commuter benefits
Company
Great American Insurance Group
Great American Insurance Group is an insurance company that specializes in in property and casualty insurance. It is a sub-organization of American Financial Group.
5001-10000 employees
H1B Sponsorship
Great American Insurance Group has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
Funding
Current Stage
Late StageTotal Funding
unknown2021-01-27Acquired
Leadership Team
Annette Gardner
Senior Vice President, Chief Financial Officer and Treasurer
M
Miguel Angel Maldonado
CFO Mexico - Automobile and Specialty Divisions
Recent News
2026-01-12
Company data provided by crunchbase