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Senior Stop Loss Claims Auditor

Senior Stop Loss Claims Auditor

Risk StrategiesSan Jose, CA, US
17 hours ago
Job type
  • Full-time
Job description

Senior Stop Loss Claims Auditor

The Senior Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files to ensure compliance, accuracy, and adherence to company procedures and regulatory requirements.

Your Impact

  • Perform in-depth claims file reviews for accuracy and compliance.
  • Document findings and provide recommendations for corrective action.
  • Identify trends and collaborate with departments to improve claim practices.
  • Support audit reporting and analytics.

Successful Candidate Will Have

  • Bachelor's degree preferred; CPCU, AIC, or other insurance certifications a plus.
  • 4 - 6 years of claims or audit experience (specific stop loss or first dollar medical).
  • Strong understanding of claims handling and insurance regulations.
  • Analytical, organized, and skilled in Excel / audit systems.
  • At Risk Strategies Company, base pay is one part of our total compensation package, which also includes a comprehensive suite of benefits, including medical, dental, vision, disability, and life insurance, retirement savings, and paid time off and paid holidays for eligible employees. The total compensation for a position may also include other elements dependent on the position offered. The expected base pay range for this position is between $51,800 -$75,000 annually. The actual base pay offered may vary depending on multiple individualized factors, including geographical location, education, job-related knowledge, skills, and experience.

    Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, Risk Strategies serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and over 5,000 employees across the US and Canada.

    Our industry recognition includes being named a Best Places to Work in Insurance for five years (2018-2022) and on the Inc. 5000 list as one of America's Fastest Growing Private Companies. We are committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues.

    Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other legally protected characteristics.

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    Senior Auditor • San Jose, CA, US

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