Claims Auditor

PRO IS Inc • Remote, US,

1d • Remote

About The Position

PRO IS, Inc. currently has an exciting Claims Auditor position available within our audit team. This client-facing role would suit experienced, highly motivated candidates who are able to handle multiple demands with a sense of urgency, drive, and energy while growing and maintaining client relationships. This role is fully remote within the USA but it may include some travel within the USA.

Requirements

• Minimum of 5 years insurance claims experience is required with a demonstrable track record of auditing and business and client relationship development.
• Bachelor’s degree in business administration or similar field.
• Must have successfully completed one or more of the educational programs through the Insurance Institute of America or the Professional Insurance Agents, such as, Chartered Property Casualty Underwriter (CPCU), Program in General Insurance, Associate in Claims (AIC), etc.
• Equivalent education, work experience, knowledge, and skills may qualify.
• Excellent working knowledge of insurance claims; having experience reviewing claims being submitted to our clients.
• Highly structured and conceptual mindset coupled with strong quantitative and analytical problem-solving aptitude.
• Excellent written and oral communication skills.
• Detail orientated, with excellent organizational and planning skills.
• Ability to work independently, with a team, and with initiative is essential.
• Ability to travel within the USA up to 10% of the time.
• Must be fully authorized to work for any US employer.

Responsibilities

• Manage multiple audit engagements and lifecycles at one time: overseeing the entire audit process including compiling data from third-party administrator on claims handling structure and requesting information in preparation for the audit.
• Audit Third-Party Administrators and Client Claims Teams to ensure adherence to contractual agreements, SLAs, industry standards, and regulatory requirements.
• Review pre audit questionnaire (PAQ) responses and necessary documentation; drafting follow-up questions and inquiries as needed.
• Manage communication, preparatory, onsite/remote, wrap up, meeting, and post audit/reporting activities.
• Analyze claims data to identify trends, exposures, and comparing to best practices.
• Evaluate any liability or coverage decisions to evidence appropriate claims handling decisions.
• Write professional, detailed reports and appendices; if required or if significant issues identified, prepare the initial summary assessment of findings for client.
• Liaise with Audit Administrator regarding audit preparations and MGA/Coverholder/TPA readiness.
• Refer to Peer Reviewer before releasing to client.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level