Senior Specific Claim Auditor

January 2, 2026

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Great American Insurance Group is a leader in the insurance industry, offering opportunities for growth and collaboration. The Senior Specific Claim Auditor will be responsible for validating incoming stop-loss claims, maintaining compliance, and providing guidance to clients on claims procedures.

Responsibilities

Receive, log, and validate incoming stop-loss claims and related documentation; request missing information as needed
Verify eligibility, plan benefits, and stop-loss policy provisions; accurately enter claim details into the system of record
Maintain electronic claim files for audit and compliance purposes. Review, analyze, and adjudicate high-dollar and complex medical stop-loss claims; Identify cost-containment opportunities and implement strategies with carriers and TPAs
Document audit findings and maintain accurate records in the system
Communicate effectively and respond timely to TPAs, brokers, policyholders, and internal teams; provide clear updates on claim status and documentation requirements
Offer guidance to clients on claims procedures and coverage issues
Ensure adherence to regulatory requirements, internal controls, and fraud prevention policies
Stay current on industry trends, regulations, and best practices; participate in special projects, reporting, and process improvement initiatives
Identify opportunities to streamline claim intake and processing workflows
Train and mentor junior claims processors on best practices
Perform other duties as assigned

Skills

Minimum 10 years in medical stop-loss claims processing or related health insurance claims roles
Proficiency in medical coding (ICD-10, CPT, HCPCS); advanced Excel skills; expertise with claims processing systems
Strong understanding of stop-loss insurance, plan documents, and claims handling practices
Exceptional analytical ability, attention to detail, and strong written and verbal communication skills

Benefits

Medical, dental, and vision coverage
Wellness plans
Parental leave
Adoption assistance
Tuition reimbursement
Paid Time Off
Paid holidays
A 401(k) plan with company match
An employee stock purchase plan
Commuter benefits

Company Overview

Great American Insurance Group is an insurance company that specializes in in property and casualty insurance. It is a sub-organization of American Financial Group. It was founded in 1872, and is headquartered in Cincinnati, Ohio, USA, with a workforce of 5001-10000 employees. Its website is http://www.greatamericaninsurancegroup.com.

Company H1B Sponsorship

Great American Insurance Group has a track record of offering H1B sponsorships, with 2 in 2025. Please note that this does not guarantee sponsorship for this specific role.

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