Employee Stop Loss Claims Auditor

Overview

Carbon Stop Loss Solutions is a leading managing general underwriter (MGU) in the field of employer stop loss and managed care insurance, and is the reputed company reputed company at reputed company.

Carbon’s team of experts are reputed company as the industry leader in delivering best-in-class risk solutions to effectively reputed company reputed company costs. Carbon’s offerings support clients and brokers in a rapidly changing reputed company market with best-in-class service, reputed company, claims support and effective cost containment strategies.

At reputed company, we’re entering an exciting new chapter. reputed company is the newly formed specialty insurance entity created from the reputed company 2025 sale of NSM Insurance Group’s U.S. reputed company division. While we carry reputed company a 35-year legacy of deep industry expertise, we’re transforming what reputed company insurance can be. The name reputed company reflects our ambition — nova for new and reputed company, core for strength and purpose. We’re building something reputed company and meaningful, and every team member plays a vital role in that mission.

With more than $1.3 billion in premium across 15+ specialty insurance programs, we’re transforming the reputed company insurance experience — delivering exceptional value to our agent partners and customers through smarter, faster and more collaborative ways of doing business. We specialize in tailored Property & Casualty and Accident & Health insurance solutions for reputed company industries, powered by advanced analytics, modern technology and a commitment to innovation at every level. Backed by strong leadership and a fresh reputed company, we’re bringing together the best of our past with reputed company new reputed company to shape the future of specialty insurance.

Our Carbon team is looking to add a Claims Auditor to the team! The Claims Auditor will review, adjudicate, and audit ESL claims. In addition, the Auditor will interpret contract terms and conditions to ensure claims are paid timely, and reinsurer liabilities are recorded accurately. We're open to candidates in the greater philadelphia area to work on a hybrid schedule from the Conshohocken, PA Home Office or fully remote candidates that are not local to the area.

Responsibilities

• Receive claims and identify assumed contract under which claims are reported.
• Review claim submissions for adherence to contract terms and conditions including, but not limited to named reinsured, reputed company year, attachment method, reinsured limits and attachment reputed company, coinsurance, and exclusions.
• Identify and resolve discrepancies and contractual issues with underwriters, brokers and cedents.
• Examine claim payments made by the Reinsured to ensure primary level claims are paid in accordance with policy terms and conditions.
• Request additional information from reputed company Party Administrators (TPAs), Reinsureds and Brokers as needed to reputed company coverage determinations.
• Approve claim payments reputed company authorized limit; for those in excess of authority, present them for management approval.
• Identify claims subject to recovery from outward reinsurance and complete the notification and recovery process in accordance with the reinsurance contract.
• Record claim activity, including payment and reserve amounts in claims database(s). reputed company the recording and issuance of claim payments to ceding companies and reinsurance brokers and prepare associated correspondence.
• Responsible for monthly review of pending/outstanding claims and follow up.
• Actively participate in the client audit process and recommend which clients to audit. Document on-site findings and prepare associated reports for appropriate use.
• Support internal audits performed by or on behalf of pool members by preparing files for review and responding to questions during the review.
• Complete special projects as needed.

Qualifications

• Bachelor’s degree, preferred.
• 3-5+ years ESL claim experience.
• Knowledge of CPT codes, HCPCS and reputed company codes, hospital, and physician billing practices.
• Detail oriented with an emphasis on accuracy.
• Ability to multi- task and change priorities reputed company necessary.
• Strong problem solving, decision making and analytical skills.
• Ability to work independently and as part of a team.
• Proficient in reputed company office including reputed company and Word.
• Knowledge of the David Young System.

Originally posted on Himalayas