Claims Compliance Audit Specialist
New
K
Kin InsuranceInsurance
For all other positions, these roles can sit in any of the following 40 states: AL, AR, AZ, CA (exempt only), CO, CT, FL, GA, ID, IL, IN, IA, KS, KY, MA, ME, MD, MI, MN, MO, MT, NC, NE, NJ, NM, NV, NY, OH, OK, OR, PA, SC, SD, TN, TX, UT, VT, VA, WA, and WI.Full-TimeMiddle
Salary75,000 - 95,000 USD per year
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Job Details
- Experience
- 3+ years of claims compliance or 5+ years of claims experience
- Required Skills
- Project ManagementData Analysis
Requirements
- 3+ years of claims compliance or 5+ years of claims experience
- Deep understanding of homeowners policies, claim processes and legal and regulatory landscape of the insurance industry
- Ability to proactively identify systemic trends and emerging risks across claim files
- Capability to evaluate claims against established technical and compliance standards
- Experience in transforming project management into a strategic driver
- Familiarity in bringing alignment to cross-functional teams, navigating competing priorities
- Commitment to maintaining the highest ethical standards
Responsibilities
- Conduct technical reviews of claim files and compliance check points to evaluate claim handling, documentation, coverage application, and adherence to company standards and regulatory requirements.
- Analyzing state-specific claims handling requirements and documenting their impact on Claims processes and operations.
- Identifying quality, technical, and compliance trends and translating findings into actionable insights for leadership and stakeholders.
- Executing monitoring and testing of claims compliance controls and recommending improvements where gaps are identified.
- Participating in calibration discussions to ensure consistent interpretation and application of claim handling standards and expectations.
- Contributing to the development and refinement of audit tools, reporting processes, and review standards.
- Collaborating with Training, Claims Leadership, and Automation teams to address identified trends and improve claims handling practices.
- Drafting and updating Standard Operating Procedures and processes based on audit findings, regulatory changes, and business needs.
- Acting as the go-to resource for peers by providing guidance on unique claims scenarios, offering coaching, and contributing to team training and knowledge sharing.
- Supporting the execution of claims compliance projects by coordinating tasks, monitoring progress and risks, and ensuring timely delivery of project milestones and regulatory requirements.
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