SECURA Insurance

Claims Auditor

US-WI-Appleton
3 weeks ago
Job ID
2097
Job Grade
Grade 8
Category
Claims

Overview

Responsible for providing leadership to SECURA’s Claims Auditing Function. This includes performance of both compliance and specialty audits of individual claims files and individual claim reps, generating reports, summarizing and presenting audit findings, and working collaboratively with all relevant stakeholders.  The purpose of this role is to provide visibility into claims quality through an ongoing review of open and closed claims files against best practices and handling guidelines and to provide suggestions for improvement opportunities.

Responsibilities

(Includes the following, other duties may be assigned)

  • Responsible for providing select audit functions across the Claims Division.
  • Collaborate with all stakeholders (Claims Management, Claims Trainer, Internal Audit, Corporate Legal, State OCI, and Reinsurers) to establish an annual audit plan for the year.
  • Perform compliance and specialty audits by evaluating claims files against established best practices for consistency and accuracy.
  • Evaluate individual Claims Representatives performance to ensure compliance with SECURA best practice performance standards.
  • Identify development opportunities and work closely with Claims Management and the Claims Trainer to ensure any gaps are brought to their attention and training is provided as needed.
  • Summarize and present results for all audit measurements performed and share with Claims Management and Internal Audit.
  • Assist Claims Management with developing measurements, ongoing audit checklists, action plans and best practice methods to mitigate risks in the claims handling process and ensure consistent claims handling across the Claims Division.
  • Gain a working knowledge of audit industry best practices.
  • Build and enhance individual development and skill-set by seeking educational opportunities and participating in available training to provide strong departmental support.
  • Guide the implementation of corporate compliance best practices by establishing and maintaining policies, procedures and related controls that are tailored to the SECURA Claims Department and that meet relevant regulatory requirements and address needs of the business
  • Monitor the effectiveness of the compliance program by testing current compliance control processes, auditing program activities and managing incidents to ensure continuous adherence to laws and regulations.
  • Foster a streamlined approach to corporate compliance by implementing system solutions to automate and/or strengthen compliance controls and drive efficiency and effectiveness of department initiatives
  • Drive an approach that focuses on collaboration by networking with the business as well as openly communicating and engaging with key stakeholders such as Claims Management, Claims Trainer, Corporate Legal, Internal Audit, Reinsurers, and State OCI.
  • Professional, polished, poised and positive demeanor.
  • Communicate information in a clear, well-organized, and professional manner.

Qualifications

  • Must be able to develop strong business relationships with key stakeholders.
  • Must have a working knowledge of P&C claims insurance industry products and services.
  • Must have a working knowledge of P&C claims file handling quality assurance procedures with a desire to help drive consistent and compliant claims file handling.
  • Must have the ability to objectively evaluate P&C Claims file handling performance.
  • Must have outstanding interpersonal and communication skills.
  • Must have the ability to work independently with little supervision or direction.
  • Strong organizational, analytical and legal research skills helpful.
  • Working knowledge of SECURA Claims System helpful.
  • Bachelor's degree or equivalent combination of education and work experience.

  • 5+ years related experience in the area of property and/or liability claims adjusting, subrogation adjusting, and/or claims supervision/management.

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