We are currently recruiting for a Claims Auditor / Analyst focusing on quality assurance in NYC, Hartford, CT, Chicago or Atlanta. Hybrid in-office 2 days per week. This is a great opportunity to join a growing Claims Operations team, where you'll have the chance to work with a variety of commercial insurance products and engage with leaders. This role is vital for ensuring quality, continuous improvement, and shaping best practices. The Claims Auditor / Analyst conducts regular quality assessments of claim files, aligning with our regulatory and quality framework to promote business-wide enhancements. 105K – 115K base + Bonus + Benefits Package
Responsibilities:
- Execute internal and TPA claim quality assurance reviews in accordance with claims best practices and regulatory standards.
- Generate detailed analytical reports that highlight claims findings and trends, and prioritize identified issues.
- Analyze data and communicate audit results and reports to key stakeholders.
- Evaluate claim outcomes/resolutions against best practices or TPA claim handling guidelines, and collaborate with the Claims Quality Assurance Manager to offer constructive, objective feedback, including suggestions for enhancements, training, and corrective measures.
- Manage the month-to-month claim review process to ensure consistent evaluation of all eligible file handlers.
- Organize daily, weekly, and monthly tasks to meet output goals.
- Work with the QA team and business units on continuous improvement and training efforts.
Requirements:
- 3+ years of prior claims auditing / QA experience or a related background and 5+ years of experience in handling multi-line claims (General Liability, Professional Liability, and/or Property/Inland Marine lines of business).
- Must have excellent written and verbal communication skills, proven organizational and time management abilities, a thorough understanding of claims regulatory requirements and operational risks.
- Experience in legal or regulatory compliance, familiarity with state Department of Insurance standards, a history of outstanding customer service, and a proven ability to manage stakeholder relationships.
- An awareness of current market trends, insurance compliance, and risk and regulatory concerns is also essential.
To apply email resume to petrina@bellwetherstaffing.com