AI
Title
Senior Claims Quality Auditor
Overview of Position
The Senior Claims Quality Auditor reviews both internal claim files and external Third Party Administered handled claim files using a standard form to confirm proper claims handling adherence to the Fair Claims Settlement Regulations set for by the Dept of Insurance as well as following specific proprietary claims handling instructions on service standards. The audit is designed to be an accurate
assessment of the claims handling process providing results that identify strengths and opportunity areas where improvement is needed to safeguard the company’s interest. The auditor prepares a monthly summary report explaining deficiencies, issues, or inquiries concerning the claims handling process.
What will be my duties and responsibilities in this job?
• Complete both internal adjuster & external TPA and IA handled open and closed claim file audits.
• Determine whether claims handling is aligned with the Fair Claims Settlement
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