Senior Claims Quality Auditor

Title 

Senior Claims Quality Auditor

Overview of Position

The Senior Claims Quality Auditor reviews both internal claim files and external Third Party Administered handled claim files using a standard form to confirm proper claims handling adherence to the Fair Claims Settlement Regulations set for by the Dept of Insurance as well as following specific proprietary claims handling instructions on service standards.  The audit is designed to be an accurate
assessment of the claims handling process providing results that identify strengths and opportunity areas where improvement is needed to safeguard the company’s interest. The auditor prepares a monthly summary report explaining deficiencies, issues, or inquiries concerning the claims handling process.

What will be my duties and responsibilities in this job? 

• Complete both internal adjuster & external TPA and IA handled open and closed claim file audits.

• Determine whether claims handling is aligned with the Fair Claims Settlement
  Regulations.

• Collaborate with management in accounting, billing, claims, and actuarial
  identifying risk and potential training opportunities discovered from audits.

• Prepares comprehensive reports as required by Clients, and business leaders
  and facilitates meetings with Clients, Actuarial, Accounting, Internal Audit, and
  internal Claims leadership on results identify trends and communicating
  necessary action plans needed to reduce regulatory risk and outcomes.

• Maintain and update all documents pertaining to audit form, controls, processes, job aids, and bulletins.

• Assists with internal audits (departmental expense audits, T&E audits, General
  Supplies audits, etc.)

• Act as the liaison to external Vendors as well as internal Vendors, Ethics, and
  Audit to help the groups work effectively with each other by answering questions effectively, resolving conflicts quickly, and encouraging collaboration.

• Serve as technical resource to both internal & external teams.  

What are the requirements needed for this position? 

• Adjusters License will be required in all states where adjuster licensing is applicable.  

• Minimum 5 years in property claims or equivalent related P&C insurance experience.

• P&C Claims adjusting experience to include a strong level of knowledge in adjusting claims and interpretation of policy coverage and provisions,
  exposures, evaluation of the compensability of the claim, departmental standards, and state laws governing compliance.

• Prior auditing experience. (May include Quality Audits, Fraud Assessment Audits, Financial Audits, Expense Audits. etc.)

• Strong working knowledge of all currently used estimating platforms (example Xactimate).

• Strong working knowledge of all currently used estimating platforms (example Xactimate).

• Excellent verbal and written skills to communicate internally and
  externally.

• Excellent critical thinking skills

• Strong organization and time management skills

What other skills/experience would be helpful to have? 

• College degree preferred

• Ability to multi-task in fast-paced environment.

What are the working conditions and physical requirements of this job?  

General office demands  

#LI-Remote

Pay Range:

$72,900.00 - $121,900.00

Any posted pay range considers a wide range of compensation factors, including candidate background, experience and work location, while also allowing for salary growth within the position.

Expected application deadline is

If date is blank then this is a pipeline requisition, and we will continue to collect applications on an ongoing basis.

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