Funding Auditor

About the role

The Funding Auditor supports the financial integrity of traditional self-funded and level-funded employer groups by validating funding activity, reconciling claim payments to expected funding, and partnering with internal teams to ensure accurate reporting and issue resolution.

Responsibilities

• Partners closely with the Stop-Loss team to obtain, review, and reconcile transaction detail, claim reimbursement reports, and payment files ensuring stop-loss recoveries are accurately reflected and aligned with underlying claims activity and plan terms.
• Captures and transfers funds from the reinsurance accounts to the appropriate employer or payor funding accounts, ensuring funds are moved in accordance with contractual requirements, internal controls and established funding deadlines.
• Accurately applies stop-loss and reinsurance proceeds to applicable claims and funding accounts, verifying proper allocation of claim, plan year, and funding source, while resolving discrepancies to ensure complete and accurate account balances.
• Prepares, reviews and submits stop-loss reimbursement and funding requests to employer groups and internal stakeholders, ensuring claims activity and funding levels are sufficient to support paid and pending claims while maintaining required account thresholds.
• Conducts detailed account audits across multiple plan years, validating funding accuracy, claims payments, reimbursements, and transaction history, and ensuring all activity is properly documented and supported.
• Audits traditional self-funded accounts to confirm balances, funding transactions, and claims activity are accurate, complete, and compliant with plan terms, stop-loss agreements and internal audit standards.
• Leverages proprietary AI-enabled platforms to enhance accuracy, efficiency, and insight across funding, reinsurance, and audit activities.
• Performs other projects, duties, and tasks, as assigned.

Requirements

• High School diploma or equivalent required.
• Associate’s or Bachelor’s degree in Accounting, Finance, Business, Healthcare Administration, or related field preferred.
• Previous experience in health benefits administration, billing/funding, audit support, claims, or insurance operations preferred.
• Prior experience with reinsurance preferred.
• Familiarity with claim software systems is helpful.
• Strong attention to detail and ability to follow written procedures in a compliance-sensitive environment.
• Demonstrated ability to accurately and consistently enter data.
• Self-motivated with the ability to manage routine tasks independently.
• Intermediate computer proficiency, specifically with Microsoft Excel (filters, pivots), and the ability to learn new systems.

Qualifications

• High School diploma or equivalent required.
• Associate’s or Bachelor’s degree in Accounting, Finance, Business, Healthcare Administration, or related field preferred.
• Previous experience in health benefits administration, billing/funding, audit support, claims, or insurance operations preferred.
• Prior experience with reinsurance preferred.
• Familiarity with claim software systems is helpful.
• Strong attention to detail and ability to follow written procedures in a compliance-sensitive environment.
• Demonstrated ability to accurately and consistently enter data.
• Self-motivated with the ability to manage routine tasks independently.
• Intermediate computer proficiency, specifically with Microsoft Excel (filters, pivots), and the ability to learn new systems.

Skills

• Attention to detail
• Ability to follow written procedures
• Intermediate computer proficiency, specifically with Microsoft Excel (filters, pivots)
• Strong communication skills
• Ability to work independently
• Experience with claim software systems
• Experience with reinsurance

Benefits

• Competitive pay
• Safe and healthy work environment
• Family health and wellness programs
• 401K
• Employee assistance programs
• Paid time off
• Paid holidays

Pay

$23.56 - $29.33 per hour

Schedule

Full-time