[Hiring] Claims Auditor REMOTE USA
Position: Claims Auditor (Remote)
Date Posted: October 7, 2025
Industry: Health Insurance / Consulting
Employment Type: Full Time
Experience: 5+ years in health claims adjudication, preferably in consulting, major insurance claims administrator, or health plan environment
Qualification: Estimated Qualification like Bachelor Degree holder, Diploma/Degree/Certificate
Salary: $80,000 – $90,000 USD + eligible for annual short-term incentive bonus
Location: Chicago, IL [REMOTE]
Company: WTW
Description:
Claims Auditor (Remote)
Chicago, IL About the job
As a Lead Auditor, you will leverage your auditing, project management, and client management expertise to lead client audits. Acting as the team leader and primary contact with administrators, you will review discrepancies identified by field auditors, re-adjudicate claims, resolve open issues, and draft the final report. Additionally, you will contribute to developing new tools and methodologies to improve audit processes.
The Responsibilities
- Conduct pre-implementation and coverage-specific audits, documenting all findings accurately
- Understand client plans and brief the team on unique provisions/issues before audits
- Adjust workloads to ensure successful project completion
- Communicate clearly and professionally with vendors and the audit team
- Review documentation of potential discrepancies for thoroughness and accuracy
- Resolve post-audit activities accurately and promptly
- Draft quality, value-added reports in a timely manner
- Participate in client presentations of findings, when requested
- Understand vendors’ processes and operational challenges to incorporate into daily work
- Build working relationships with vendor counterparts
- Distribute individual claim/work queues to the team efficiently
- Utilize audit-specific analytical techniques, tools, and processes effectively
- Adhere to Professional Excellence protocols
- Meet billable hours targets
- Identify opportunities to enhance work processes and methods for better quality and service
- Work remotely within the posted locations
Qualifications
- 5+ years’ experience in health claims adjudication, preferably in consulting or a major insurance claims administrator/health plan
- Strong understanding of health and welfare plan design and claims administration processes
- Familiarity with all plan types including consumer-driven, PPO, Indemnity, and Managed Care
- High-level claims administration knowledge, including 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 a strong work ethic
- Self-directed and capable of working with minimal supervision
- Previous internal audit experience at a carrier or third-party external audit experience is a plus
Compensation And Benefits
- Base salary: $80,000 – $90,000 USD
- Eligible for annual short-term incentive bonus
Company Benefits
- Health and Welfare: Medical, Dental, Vision, Health Savings Account, Commuter Account, Flexible Spending Accounts, Group Accident, Group Critical Illness, Life Insurance, AD&D, Group Legal, Identity Theft Protection, Wellbeing Program, and Work/Life Resources
- Leave Benefits: Paid Holidays, Annual Paid Time Off, Short-Term Disability, Long-Term Disability, Bereavement, FMLA, ADA, Jury Duty, Military Leave, Parental and Adoption Leave
- Retirement Benefits: Qualified contributory pension plan (if eligible) and 401(k) plan with annual non-elective company contribution; non-qualified retirement plans for eligible senior-level colleagues
WTW supports flexible work arrangements and hybrid work styles tailored to the team, role, and client needs. Employment-based non-immigrant visa sponsorship/assistance is not available for this position.
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