Skyward Specialty Insurance · 15 hours ago
Senior Claims Auditor - Accident & Health
Kennesaw, GA
Full-time
Hybrid
Mid, Senior Level
$90K/yr - $110K/yr
3+ years expSkyward Specialty Insurance is seeking an experienced and detail-oriented Senior Accident and Health Claims Auditor to join their team. The role involves conducting thorough audits of claims, ensuring compliance with policies and regulations, and providing leadership in audit initiatives.
InsuranceLife InsuranceProperty Insurance
Responsibilities
Claims Audit: Conduct thorough audits of accident and health insurance claims to verify accuracy, policy compliance, and proper adjudication
Compliance Verification: Ensure claims adhere to company policies, industry regulations, and legal requirements, including HIPAA
Data Analysis: Analyze claims data to identify patterns, discrepancies, and opportunities for process improvement
Reporting: Prepare detailed audit reports and communicate findings, recommendations, and corrective actions to management and relevant departments
Process Improvement: Collaborate with claims processing teams to implement audit recommendations, streamline workflows, and enhance claims accuracy
Training & Mentorship: Serve as a subject matter expert by training junior auditors and claims processors on audit procedures and compliance standards
Documentation: Maintain accurate documentation of audit processes, findings, and follow-up actions, ensuring all information is safeguarded and confidential
Continuous Learning: Stay updated on changing regulations, industry best practices, and emerging audit methodologies
Qualification
Required
Bachelor's degree in business, Insurance, or related field (preferred)
Minimum 3+ years in experience in medical claims auditing and processing in accidental and health insurance claims
Robust knowledge of claims processing systems, protocols, and regulatory requirements
Excellent analytical, problem-solving, and decision-making skills
Strong attention to detail and organizational abilities
Preferred
Advanced knowledge of claims processing guidelines, medical terminology (ICD-10, CPT, HCPCS, UB04), and insurance concepts (UCR, COB, HIPAA, subrogation)
Familiarity with eligibility guidelines and group health plan administration (Medicare, COBRA, FMLA, etc.)
Strong analytical skills with attention to detail and proficiency in interpreting Plan Documents and reinsurance contracts
Excellent written and verbal communication skills with proven customer service
Effective problem-solving, team partnership, and project management abilities
Proficiency with claims processing systems and Microsoft Office Suite (Word, Excel, PowerPoint)
Ability to foster a collaborative team environment and drive continuous improvement initiatives
Benefits
Health and welfare benefits
Tuition and professional certification assistance
401k savings
Elective participation in the Employee Stock Purchase Program
Paid time off
Paid holidays
Child bonding leave
Other employee assistance
Company
Skyward Specialty Insurance
Skyward Specialty is a rapidly growing and innovative specialty insurance company, delivering commercial P&C products and solutions on a non-admitted and admitted basis.
501-1000 employees
Funding
Current Stage
Public CompanyTotal Funding
$375.65M2024-05-06Post Ipo Secondary· $177.3M
2023-11-13Post Ipo Secondary· $22.88M
2023-11-13Post Ipo Equity· $86.92M
Leadership Team
Andrew Robinson
CEO
Christopher Zitzmann
President - Inland Marine and Transactional Property
Recent News
GlobeNewswire
2026-01-16
Beinsure - Insurance, Reinsurance, InsurTech Insights
2026-01-14
2026-01-05
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