Claims Auditor

Description We are looking for a detail-oriented Claims Auditor to join a Financial Services organization in Omaha, Nebraska. In this role, you will evaluate benefit and insurance claim submissions, apply policy provisions accurately, and help ensure timely, well-documented payment decisions. This position is ideal for someone who combines analytical judgment, strong written communication, and a commitment to handling sensitive information with care.

Responsibilities:

• Examine claim forms, supporting records, and benefit requests to determine coverage eligibility and decide whether claims should be approved, declined, or held pending additional documentation.
• Record claim activity, decisions, and supporting details in the claims administration system with a high degree of accuracy and completeness.
• Prepare written communication to claimants, beneficiaries, financial institutions, medical providers, attorneys, and internal partners to explain outcomes or request missing information.
• Assess medical documentation, application details, and policy exclusions to confirm whether coverage requirements were satisfied at issue and escalate questionable disclosures for legal review when appropriate.
• Validate beneficiary information on life claims to confirm that proceeds are directed to the correct eligible party.
• Review applicable state regulations during life claim processing, including required beneficiary verification checks related to child support compliance.
• Recognize indicators of suspicious activity, document concerns thoroughly, and refer potential fraud matters to the appropriate legal team.
• Respond to questions from sales partners, account contacts, and internal teams regarding claim status, benefit determinations, and related service issues.
• Monitor open items and follow through on pending claims to obtain outstanding records and keep cases moving toward resolution.
• Support departmental workflow by assisting with cross-coverage, special assignments, and collaboration across teams to resolve issues efficiently. Requirements
• Associate degree in Business or a related field, or an equivalent combination of education and relevant experience.
• At least five years of experience in claims auditing or claims review with increasing responsibility.
• Practical background in resolving customer or client service issues in a detail-oriented setting.
• Strong computer proficiency, including the ability to navigate multiple software applications and maintain accurate electronic records.
• Working knowledge of claims processing, claims data review, and insurance claim evaluation.
• Ability to safeguard confidential and sensitive information with discretion.
• Insurance coursework or industry designations are preferred.
• Previous exposure to credit insurance, life claims, or medical terminology is beneficial.

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