季节性高级索赔审计员/顾问

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.
One80 Intermediaries is seeking a Seasonal Senior Claims Auditor/Consultant to join our growing team!
    
The Senior Claims Consultant is responsible for the effective management, review, adjudication, and resolution of complex Employer Stop Loss claims within established authority levels. This position provides senior-level technical expertise in claims analysis, contract interpretation, claim payment accuracy, eligibility, large-loss management, reserving, and audit oversight.

The Senior Claims Consultant works closely with the Vice President of Claims, claims team, Underwriting, brokers, Third-Party Administrators (TPAs), medical vendors, carriers, reinsurers, and other internal and external stakeholders to ensure claims are processed accurately, efficiently, and in accordance with policy terms, contractual requirements, regulatory standards, and company procedures.
How You Will Contribute:  
· Manage and adjudicate a portfolio of complex Employer Stop Loss claims within established authority levels and in accordance with policy and contract provisions.
· Review and interpret Stop Loss policies, certificates, plan documents, eligibility provisions, deductibles, exclusions, reimbursement provisions, and other applicable contractual terms to determine claim eligibility and reimbursement.
· Conduct comprehensive reviews of high-dollar, complex, and unusual claims, including claims involving significant medical expenses, transplant, oncology, catastrophic conditions, specialty drugs, and other high-cost services.
· Analyze claims data, medical records, eligibility information, provider documentation, invoices, and other supporting documentation to validate claim accuracy and reimbursement.
· Review claims for appropriate adjudication, including eligibility, deductibles, exclusions, benefits, payment calculations, and application of policy terms.
· Manage large-loss claims and provide timely reporting, analysis, recommendations, and escalation to the Vice President of Claims and other appropriate stakeholders.
· Review and recommend appropriate reserves for large and complex claims based on available information, anticipated claim liability, policy provisions, and established reserving guidelines.
· Monitor large claims throughout their lifecycle and update reserves, claim estimates, and management reports as new information becomes available as requested by VP of Claims.
· Conduct pre- and post-payment claim audits to identify payment inaccuracies, processing errors, documentation deficiencies, and opportunities for recovery or correction.
· Identify trends, recurring errors, system issues, and process deficiencies affecting claim accuracy or financial performance and recommend appropriate corrective action.
· Work closely with TPAs and external claims administrators to resolve complex claims issues, validate claim information, and ensure adherence to contractual and administrative requirements.
· Manage inquiries and escalated claim matters from brokers, TPAs, plan sponsors, Underwriting, reinsurers, and other stakeholders, providing clear, timely, and professional responses.
Skills & Experience to be Successful:
· Bachelor's degree required.
· Minimum of seven (7) years of progressive experience in claims, with significant experience in Employer Stop Loss, medical claims, health benefits, or a related insurance environment.
· Demonstrated experience handling complex and high-dollar medical claims.
· Experience with claims auditing, adjudication, payment review, and claims analysis.
· Experience interpreting insurance contracts, plan documents, and claims provisions.
· Experience managing large-loss claims and making reserve recommendations.
About One80:
One80 Intermediaries is part of Arrowhead Intermediaries, a global insurance distribution platform that offers deep specialization, scale, and innovation across wholesale brokerage, program administration, and specialty insurance. With more than 7,000 professionals worldwide and a collective portfolio exceeding $18 billion in premium placed in 2024, our combined organization delivers a diverse trading platform for insurance carriers as well as expanded access and niche solutions for brokers and customers navigating complex and hard-to-place risks. The platform combines entrepreneurial culture with operational excellence to deliver tailored solutions and long-term value across the insurance ecosystem.
Pay Range
$65.00 - $65.00 HourlyThe pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role.
Teammate Benefits & Total Well-Being
We go beyond standard benefits, focusing on the total well-being of our teammates, including:

• Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance

• Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement

• Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services

• Beyond Benefits: Paid Time Off, Holidays, Preferred Partner Discounts and more.

Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations.

Recruiting Vendor Disclosure Statement
Brown & Brown does not accept unsolicited resumes from external recruiters, recruitment vendors or employment agencies ("Recruiting Vendors"). Recruiting Vendors must have a valid written agreement and received prior written authorization from an authorized Brown & Brown representative before submitting candidates for any publicly posted role. Any unsolicited resumes submitted to Brown & Brown or its employees become the property of Brown & Brown, and no fees will be paid for such submissions. Additional information regarding this policy can be found on our careers page.
The Power To Be Yourself
As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.
Originally posted on Himalayas