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Develop and implement quality compliance standards, policies, procedures, practices, processes, tools, and documentation for Claims.
Review and report on third party administrator performance.
Reviews audit results to determine proactive methods to improve results and address deficiencies identified in the audit.
Structure and organize compliance related matters such as letter compliance, timing requirements by state, and review of DOI market conduct exams.
Leads the planning, implementation and execution of Claims compliance projects from initiation to completion.
Ensure the project results meet requirements regarding technical quality, reliability, schedule and cost.
Maintain up-to-date knowledge of changes in laws impacting claim operations
Coordinate with other claim personnel and functional departments in the development of new products, coverages and forms.
Analyzes and evaluates regulatory exposures of the company.
Training of personnel based on new laws, compliance matters, and audit findings.
Perform other job-related duties requiring the same general knowledge, skills and degree of responsibility commensurate with assigned level.
Technical expertise in claim processes, procedures and laws as well as a thorough understanding of the assigned specific claim line (i.e., Commercial General Liability, Workers' Compensation, Property, Commercial Auto).
Knowledge of property and casualty estimating tools.