[Hiring] Claims Auditor REMOTE USA
Position: Claims Auditor
Date Posted: August 24, 2025
Industry: Insurance / Health Claims / Consulting
Employment Type: Full Time
Experience: 5+ years
Qualification: Estimated qualification: Bachelor’s degree holder in Health Administration, Business, or related field
Salary: $80,000 – $90,000 USD
Location: Chicago, IL, United States / REMOTE
Company: WTW
Description:
About the Role
WTW is seeking an experienced Claims Auditor to lead and manage client audits while ensuring accuracy and compliance in claims adjudication. This remote position involves serving as the primary interface with administrators, reviewing discrepancies identified by field auditors, resolving open issues, and drafting comprehensive reports. The role also contributes to the development of audit tools and improved methodologies.
Key Responsibilities:
• Conduct pre-implementation and coverage-specific audits and document all findings accurately
• Understand client plans and brief the audit team on unique provisions or issues
• Adjust workloads to ensure successful completion of audits
• Communicate professionally with vendors and audit teams
• Review documentation of potential discrepancies for accuracy and completeness
• Resolve post-audit activities efficiently and on time
• Prepare high-quality draft reports in a timely manner
• Participate in client presentations of findings when requested
• Understand vendor processes and operating environments, factoring them into daily work
• Develop strong working relationships with vendor counterparts
• Assign individual claim/work queues to the team promptly
• Utilize audit-specific analytic techniques, tools, and processes effectively
• Follow Professional Excellence protocols
• Meet billable hours targets
• Seek opportunities to improve audit processes and service delivery
Qualifications:
• 5+ years of experience in health claims adjudication, preferably in consulting, insurance administration, or health plan environments
• Strong knowledge of health and welfare plan design and claims administration
• Familiarity with consumer-driven plans, PPO, Indemnity, and Managed Care
• Expertise in medical, dental, mental health, and Medicare claims
• Detailed knowledge of ICD-10 and CPT codes and coding protocols
• Excellent oral and written communication skills
• Team player with strong work ethic
• Self-directed and able to work with minimal supervision
• Previous internal or third-party audit experience is a plus
Compensation & Benefits:
• Base salary: $80,000 – $90,000 USD
• Eligible for annual short-term incentive bonus
• Comprehensive benefits package including medical, dental, vision, prescription coverage, health savings accounts, dependent care accounts, group accident, critical illness, life insurance, AD&D, legal and identity theft protection, wellbeing programs, and work/life resources
• Leave benefits: Paid holidays, annual PTO, short-term and long-term disability, bereavement, parental leave, jury duty, and more
• Retirement benefits: 401(k) plan with company contribution, qualified pension plans, and non-qualified retirement plans for eligible senior employees
Work Environment:
• Remote, hybrid, and in-office work options depending on team, role, and client needs
• Flexible arrangements supported to encourage inclusivity and diversity
• Employment-based non-immigrant visa sponsorship not offered
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