Overview:
Our client, a respected insurance carrier, is seeking an experienced Claims Auditor to join their team. This role is responsible for conducting comprehensive audits of claims files to ensure compliance with company guidelines, regulatory standards, and industry best practices. The ideal candidate will have prior experience auditing Commercial Auto, Workers’ Compensation, or Financial Lines claims and a strong understanding of claims handling procedures.

This position plays a key role in maintaining quality standards, identifying operational improvements, and supporting continuous improvement initiatives within the claims department.

Compensation:

• $100,000 - $130,000/year (based on experience)
• Annual bonus potential
• Full medical benefits
• Lucrative 401k with company match

Responsibilities

• Conduct detailed audits of claims files across Commercial Auto, Workers’ Compensation, and/or Financial Lines lines of business.
• Evaluate claims handling practices to ensure compliance with internal guidelines, regulatory requirements, and industry standards.
• Review claim documentation, reserving practices, coverage determinations, and settlement strategies for accuracy and completeness.
• Identify trends, inconsistencies, and areas for improvement within the claims handling process.
• Prepare detailed audit reports outlining findings, recommendations, and corrective actions.
• Collaborate with claims leadership and adjusters to provide feedback and support best practices in claims management.
• Participate in quality assurance initiatives and help develop procedures to improve claims outcomes and operational efficiency.
• Track and monitor follow-up actions related to audit findings to ensure resolution and compliance.

Requirements

• 5+ years of insurance claims experience, with a focus on Commercial Auto, Workers’ Compensation, or Financial Lines.
• Prior claims auditing or quality assurance experience strongly preferred.
• Strong knowledge of claims handling procedures, coverage analysis, reserving practices, and regulatory requirements.
• Excellent analytical and investigative skills with strong attention to detail.
• Ability to review large volumes of claims files and identify trends or areas of risk.
• Strong written and verbal communication skills, including the ability to present audit findings clearly and constructively.
• Proficiency with claims management systems and Microsoft Office applications.

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