Claims Senior Casualty Auditor - Quality Assurance

Claims Senior Casualty Auditor - Quality Assurance at ACSC Management Services Inc summary:

Senior casualty claims auditor responsible for independently auditing casualty claim files to ensure regulatory compliance, accurate loss payments, and adherence to company best practices. Conducts file reviews to identify trends and anomalies, communicates with insureds/claimants, evaluates coverage and claim values, negotiates settlements within authority, and coordinates with internal/external stakeholders. Requires extensive claims handling experience, advanced knowledge of insurance principles, strong communication and leadership skills, and occasional travel.

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.

Job Duties

• 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.

Qualifications

• Bachelors Equivalent combination of education and experience Preferred
• 7-9 years Prior claims handling experience. Preferred
• 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
• Associate in Claims - Insurance Institute of America Preferred

Travel Requirements

• Occasional travel to business meetings or conferences. (5% proficiency)

The starting pay range for this position is $ 78,200.00 - $104,100 per year. Additionally, you will be eligible to participate in our incentive program based upon your team and individual performance.

Remarkable 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!)

Auto Club Enterprises is the largest federation of AAA clubs in the nation. We have 14,000 employees in 21 states helping 17 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win.

All of Us! With our national brand recognition, long-standing reputation since 1902, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.

"Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”

AAA is an Equal Opportunity Employer

Keywords:

casualty claims audit, claims quality assurance, insurance compliance, loss payment accuracy, claims negotiation, coverage determination, subrogation and fault assessment, claims reporting and analytics, claims software proficiency