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Auto Claims Auditor
4 months ago
**Duties & Responsibilities**
- Conducts comprehensive and follow up Focused Department Reviews of assigned insurance claims and report findings to the impacted Focused Department to ensure the accuracy of the following:
- File documentation
- Compliance with internal policies, statutory regulations, and industry best practices
- Timely and consistent customer service levels & claims decisions provided
- Risk mitigation
- Adherence to business units' guidelines and operating policies & procedures
- Alignment with industry and company best practices
- Finalize and provide the initial report and action plan recommendations to the impacted business unit's leadership and monitor for final action plan from impacted business unit.
- Facilitate meetings with the impacted business unit's leadership team, senior management and Claims Training & Systems Development unit to present final report and impacted business unit's action plan.
- Provide proper follow-up and oversight of the execution and completion of the business unit's finalized action plan.
- Develop Legal/Compliance's departmental guidelines to assist other business unit's alignment with internal policies, statutory regulations, and industry best practices and update as needed to comply with other impacting regulatory or operational changes.
- Supports Claims Training & Systems Development unit and other business units training needs in conjunction with overall regulatory compliance as needed.
- Perform additional duties as assigned by the General Counsel or Director of Compliance.
**Qualifications Required**
- Bachelor's Degree or 6+ years of personal and commercial automobile insurance claims auditing and/or similar property and casualty work experience.
- Profound technical knowledge of insurance industry and auditing of personal and commercial auto insurance with a focus on claims handling, internal policies, statutory regulations, and industry best practices.
- Robust detailed-oriented and critical thinking skills needed to interpret and communicate complex problems and solutions effectively with all levels of our organization.
- Able to utilize and manage all available resources to make informed decisions and achieve superior results.
- Seeks out to understand other business units' needs, long term goals, objectives and challenges in order to formulate recommended solutions and guidance.
- Possess strong self-management & organizational skills in order to prioritize multiple deadline-driven assignments, with ability to shift focus as needed.
- Excellent time management, written and verbal communication skills with a high level of professionalism, and attention to detail.
- Self-motivated with the ability to work independently.
- Knowledge of the following is preferred, but not required:
- Microsoft Office Suite, including OneNote and Lists.
- Viewing records in Guidewire, PTS, and ImageRight.
- Thomson Reuters' Westlaw and APCIA Compliance research resources.
