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Claims Auditor
Job
Robert Half
Omaha, NE (In Person)
Full-Time
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Job 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.