Claims Auto Adjuster - Quality Assurance

AAA • Cumberland Gap, TN

10d

About The Position

This position Audits moderate to high complexity claims matters involving material damage or liability lines of insurance written by the Interinsurance Exchange. The primary functions is to independently audit Auto Claim files across all ACE markets, with a primary focus on file handling, regulatory compliance, and loss payment accuracy. Auditors discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices. Conduct audits of auto files to identify trends, patterns, or anomalies in the claims handling process. Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data. Produce clear, concise audit write-ups that summarize findings and actionable recommendations for claim handling. Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required. Identify cross-sell opportunities based on members’ product needs and service requests. Enhance member relationship by diversifying use of products and services. Provides sales leads to insurance, travel and other departments as appropriate. The position requires a higher degree of discretion and independent judgment in analysis and problem solving to effectively manage losses. Determine policy obligations by assessing the liability and damage components of the loss. Investigate and differentiate between allegations and facts in each loss. Respond quickly and effectively to customer needs and problems. Recognize and appropriately address complex coverage issues. Recognize and appropriately address complex subrogation issues. Objectively discern and address issues that may be questioned in audit.

Requirements

• Bachelor’s or equivalent combination of education and experience.
• 7-9 years of claims handling experience.
• Advanced understanding of vehicle repair procedures and issues or building repair procedures and issues or third-party liability issues.
• Moderate computer and line of business technical software skills required.
• Moderate knowledge of fault assessment and subrogation principles required.
• Moderate leadership competencies are necessary.
• Advanced organization and planning recognition skills required.
• Advanced oral and written communication skills required.
• Advanced interpersonal skills required.
• Valid Driver's License, acceptable Department of Motor Vehicles record, and minimum liability insurance issued by state is required.

Responsibilities

• Audit moderate to high complexity claims matters involving material damage or liability lines of insurance.
• Independently audit Auto Claim files across all ACE markets, with a primary focus on file handling, regulatory compliance, and loss payment accuracy.
• Ensure compliance with state and federal law, and with established company, technical, and customer service best practices.
• Conduct audits of auto files to identify trends, patterns, or anomalies in the claims handling process.
• Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data.
• Produce clear, concise audit write-ups that summarize findings and actionable recommendations for claim handling.
• Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability.
• Coordinate with internal and external departments as required.
• Identify cross-sell opportunities based on members’ product needs and service requests.
• Enhance member relationship by diversifying use of products and services.
• Provides sales leads to insurance, travel and other departments as appropriate.
• Determine policy obligations by assessing the liability and damage components of the loss.
• Investigate and differentiate between allegations and facts in each loss.
• Respond quickly and effectively to customer needs and problems.
• Recognize and appropriately address complex coverage issues.
• Recognize and appropriately address complex subrogation issues.
• Objectively discern and address issues that may be questioned in audit.

Benefits

• Health coverage for medical, dental, vision
• 401(K) saving plans with company match AND Pension
• Tuition assistance
• Floating holidays and PTO for community volunteer programs
• Paid parental leave
• Wellness programs
• Employee discounts (membership, insurance, travel, entertainment, services and more!)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 101-250 employees