Funding Auditor

WHO WE ARE

Relation Insurance is a leading, innovative company with a strong commitment to excellence and a passion for delivering cutting-edge solutions to our clients. As a key player in the insurance market, we pride ourselves on our dynamic culture, collaborative environment, and continuous drive for success. With a rich history and a bright future ahead, we are looking for exceptional individuals to join our team and contribute to our ongoing growth and success.
 

WHAT WE’RE LOOKING FOR

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. This individual in this role bridges the gap between reinsurance (stop-loss) and funding by reviewing claim activity that impacts stop-loss reporting and ensuring related funding records align to plan performance and contractual requirements.

A GLIMPSE INTO YOUR DAY

• 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.
• Coordinates and executes the timely transfer of 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 apaid 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.

WHAT SUCCESS LOOKS LIKE IN THIS ROLE

• High School diploma or equivalent required. Associate’s or Bachelor’s degree in Accounting, Finance, Business, Healthcare Administration, or related) preferred.
• Previous experience in health benefits administration, billing/funding, audit support, claims, or insurance operations.
• 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. 

WHY CHOOSE RELATION?

• Competitive pay.
• A safe and healthy work environment provided by our robust benefit program including family health and wellness programs, 401K, employee assistance programs, paid time off, paid holidays and more.  
• Career advancement and development opportunities.

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Note: The above is not all encompassing of the full position description. 

Relation Insurance Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

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