Sr. Claims Quality Auditor

The Senior Claims Quality Auditor reviews external and internal handled claim files using a standard form to confirm proper claims handling adherence to the Fair Claims Settlement Regulations set for by the Department 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 & external TPA and IA handled open and closed claim file audits on large losses.

• 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 revealed from audits.

• Prepare 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.

• Assist with internal / external and regulatory audits

• Partner with external and internal vendors, Ethics and Audit teams and serve as a technical resource and support.

What are the requirements needed for this position? 

• High School Diploma or equivalent, although a college degree is preferred.

• 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).

•  Ability to work well with Microsoft Excel.

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

• Excellent critical thinking skills

• Strong organization and time management skills

• Ability to multi-task in fast-paced environment

Pay Range:

Any posted pay range considers a wide range of compensation factors, including candidate background, experience and work location, while also allowing for salary …