Claims Senior Casualty Auditor - Quality Assurance

AAA • East Providence, RI

3d

About The Position

Claims Senior Casualty Auditor - Quality Assurance Job Summary The Claims Senior Casualty Auditor independently audits casualty claim files across all ACE markets, with a primary focus on file handling, regulatory compliance, and loss payment accuracy. Auditor discretion and independent judgment to ensure file compliance with state and federal law , and with established company, technical, and customer service best practices. Under general supervision, works within specific limits of authority to resolve claims. Audit findings will inform key performance reporting at both the individual/unit level and up to executive leadership.

Requirements

• Bachelors Equivalent combination of education and experience
• Comprehensive knowledge of claims administration best practices and procedures.
• Advanced knowledge of insurance, fault assessment, negligence and subrogation principles required.
• Comprehensive understanding of building and vehicle repair procedures and third-party liability issues.
• Advanced knowledge of Microsoft Office suite, general computer software and claims software.
• Advanced organization and planning recognition skills required.
• Advanced oral and written communication skills required.
• Advanced interpersonal skills required.
• Advanced leadership skills among peers required.
• Exhibit proficiency and understanding of medical terminology and causality

Nice To Haves

• 7-9 years Prior claims handling experience.
• Associate in Claims - Insurance Institute of America Preferred
• Occasional travel to business meetings or conferences. (5% proficiency)

Responsibilities

• Conduct audits of Casualty files to identify trends, patterns, or anomalies in the claims handling process.
• Communicate and interact with a variety of individuals including insureds and claimants.
• Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements.
• Recognize and appropriately address moderate complexity coverage issues.
• Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data.
• Negotiate within settlement authority with insureds and claimants to resolve first and third party claims.
• Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability.
• Coordinate with internal and external departments as required.
• Independently resolve claims within authority level.

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