The Claims Quality Auditor must possess a clear understanding of the claims process, including: interpretation of policy coverage and provisions, departmental standards, and state laws governing compliance. The Auditor responsibility is to review claims files and identify weaknesses based on departmental standards and laws and making sure any non-compliance issues are discussed with manager for corrective action. The auditor prepares metric reports on a quarterly basis. These reports help managers in the development/coaching of his/her staff.

Key Responsibilities

Performs claims quality audits on a periodic basis of a randomly selected number of closed claims to ensure adherence to department claim handling standards and compliance with related laws and regulations.

Identifies potential compliance and department standard issues.

Collaborates with management identifying potential training opportunities illuminated from audits.

Meets with adjuster managers on a monthly basis

Assists with internal audits.

Auditor assists the manager with departmental expense audits, i.e. T&E audits, general supplies audits.

Assists with the preparation of records and recurring reports.

Auditor assists the manager in preparing quarterly audit results for distribution to upper management.

Engages in quality assurance activities.

Interprets and applies department standards.

Required skills/experience

• Bachelors Degree or equivalent experience.
• 3-5 years of professional claims experience or similar activity outside of the organization.
• P&C Claims adjusting experience (Auditors must possess a high level of knowledge in adjusting claims and interpreting policies).
• Advanced problem-solving skills; excellent communication and basic negotiation skills.
• PC literate with functional skills in Microsoft Office applications.

Desired skills/experience

• Prior auditing experience. (Quality Audits, Fraud Assessment Audits, Financial Audits, Expense Audits, etc).
• Specialty and Commercial lines claims experience.