Insurance Auditor

Premium Auditor

MUST RESIDE IN: (Illinois, Michigan , Iowa, Nebraska, Indiana, Ohio, Minnesota, and Missouri)

Job Duties/Responsibilities are as follows:

• Logistically plan & schedule audits throughout the entire U.S. in a timely and most cost-effective manner within the approved budget.
• Perform electronic and/or on-site premium and eligibility audits at self-administered Policy Holders and third-party administrators of policies of all types of Life and Health product. Also perform on-site audit or service calls as directed by managers of Eligibility, Premium Billing or Underwriting Departments as needed.
• Review policies thoroughly prior to the audit to discover any misunderstanding or misinterpretation by Fund/TPA/Broker/Consultant/Home Office when on-site review administrator’s administrative procedures, controls and systems as they relate to premium/fees and claims; suggest changes and improvements; review policies in force for correctness and request a Notice of Change be issued if needed.
• Obtain, review and analyze necessary data at the audit site to compile Earned vs. Paid Premium/Fee Analysis and lives verification for Aggregate Stop Loss groups.
• Verify claims paid in accordance with Office of Foreign Assets Control (OFAC) and Child Support Lien Network (CSLN) regulations when applicable for groups and third-party administrators paying claims on the Company’s behalf; verify security and number of the Company’s drafts on hand.
• Assist Premium Billing Department with collection and adjustments of premium to ensure prompt collection and follow up, as well as obtaining Lives by Location information for Premium Billing.
• Assist Stop Loss Claim Department with review of claims and potential claimant(s) in ESL to make sure attachment points and laser attachment points have been applied correctly by the Company’s Home Office and the client/ claims payer. If needed, assist in collection of necessary documents in order to process a claim (eligibility, SPD, claims, etc).
• Protect all data received from Fund, TPA or the Company in accordance with Company’s HIPAA policy.
• Protect all equipment issued by the Company (laptop, cell phone, etc.) in accordance with Company’s HIPAA policy.
• Obtain and/or verify that 50% Stop Loss notifications are being sent to the Stop Loss department.
• Assist in maintaining accurate and complete database for reporting audit results.

MINIMUM QUALIFICATIONS: The successful candidate will have a Bachelor’s Degree in Accounting, Finance or related field with three to five years of auditing experience. Must be able to travel 60% but varies throughout the year. Excellent written and oral communication skills and attention to detail are critical for this role. Must have the ability to present ideas and concepts effectively across organizational levels. Proficiency in the Microsoft Office suite including Word and Excel is required.