Claims Auditor

Background

Alan Gray LLC is a leading audit and advisory firm with over 30 years of excellence in providing a range of services to insurance-industry clients. Our goal is to help our clients realize significant bottom-line savings. Our experienced team is committed to staying current with the latest industry information and advances in technology in order to provide excellent service to our clients.

Claims Auditor:

The claim auditor will review and provide comments on workers’ compensation claim files as part of ongoing best practices audits. The auditor will apply his or her experience and training, along with specific account instructions and pertinent regulations, to evaluate all aspects of claim handling, including coverage determinations, negotiations, internal and external communications, and the notation and documentation contained in the files under review.

Please Note - This is an evergreen posting designed to build a pipeline of qualified candidates that we can contact when projects and engagements require additional talent.

Key Objectives:

• Investigate and evaluate workers' compensation claims as part of claim audits.
• Review, analyze and provide opinions as to claim handling practices of claims handled by Third Parties.
• Depending on experience and ability, the position may require project management responsibilities where the individual will direct and oversee audits and manage assigned auditors.
• Review regulatory compliance and proper handling of moderate to complex claims.
• Demonstrate proficiency in claim file management and customer service.

Qualifications:

• Strong knowledge of workers’ compensation claim handling.
• Minimum of 5 years of insurance claim experience.
• Strong organizational, file management and time management skills.
• Attention to detail; ability to prioritize.
• Demonstrated focus on quality and continuous improvement.
• Excellent written and oral communication skills.
• Strong decision-making skills.
• Adaptability and demonstrated ability to manage change.
• Strong interpersonal skills; ability to work independently and on a team.
• Analytical and strategic problem-solving skills.

Education and Experience:

• Bachelor’s degree preferred.
• Minimum of 5 years claims handling experience, including significant time handling workers’ compensation claims.
• Ability to work independently.
• Ability to work well with external parties as well as co-workers.
• Excellent verbal and written communication skills.
• Proficiency with current Microsoft Outlook and Office products.