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Job Details

Specific Claims Auditor

Company name
HCC Insurance Holdings, Inc

Santa Ana, CA

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Position Summary: Under general supervision, investigate claims liability and determine the extent of liability on a submitted claim for a specific individual. Accurately process the claim according to the policies or contracts that exist, within the departmental time frames and standards, and establish reserves for claim liability. Relying on experience and judgment, the Specific Claims Auditor is responsible for accomplishing the following assignments. These assignments are broad in nature and work can be difficult. Responsibilities: • Review and interpret employer plans of health coverage and excess insurance policy to individual claims. • Audit submitted claim documents for sufficient data, verify that benefits were paid correctly and in accordance with appropriate plans and policies, and determine liability • Communicates in writing and verbally with TPA/client as needed to resolve claim processing issues. Set claims reserves and adjusts as needed. Keep the reserves current. • Authorize checks for amount of liability and communicate to TPA/client reasons for any amounts not covered by excess policy. • Refer large dollar claims and trigger diagnosis to preliminary claims and case management departments. Planning: • Develop work plans, establish timelines, and set goals for assigned work. • Meet commitments on deadlines. Communication: • Review activities, results, and recommendations with management and clients as appropriate. Cost Management: • Drive improvement in existing business processes. • Perform work thoroughly in a cost efficient manner and at a high productivity level. Business Controls and Policies: • Comply with all corporate policies and procedures. • Report any breakdown in controls to management. • Conduct all activities in a safe manner. People Management: • No people management responsibility but may provide guidance to less experienced employees,

Company info

HCC Insurance Holdings, Inc
Website :

Company Profile
HCC Insurance Holdings, Inc. is a leading specialty insurer with offices in the United States, the United Kingdom, Spain and Ireland, transacting business in approximately 180 countries and underwriting more than 100 classes of specialty insurance. HCC products and capabilities set the standard for the industry, and many of the Company’s almost 2,500 employees are industry-leading experts.

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