Claims/QC Auditor

Essential Job Duties and Responsibilities:

• Performs claims auditing functions, including but not limited to:
  • Opening claims, assigning claim numbers, entering claims data into computer, etc. in a timely manner.
  • Checking losses to ensure that all supporting documentation is included and auditing claims according to established guidelines.
  • Entering loss information on computer system.
  • Confirming accuracy of information against error listings and corrects errors.
  • Referring problem files to appropriate supervisor or manager.
  • Answer questions from adjusters, agents, field staff, and insures about claim status and procedures.
  • Generating and distributing various reports, such as claim forms, claim progress reports, and loss drafts.
• Performs various quality control functions, including but not limited to:
  • Generating quality control documents, reports and distributing as directed.  
  • Entering completed quality control reviews on computer system.
  • Informing appropriate staff of the review process and results.
  • Making changes in policies as necessary to reflect QC audit results.
  • Maintaining records of agent and adjuster training hours as necessary.
• Assist with other duties as necessary.

Knowledge, Skills, and Abilities

• Ability to learn and apply detailed information about the Company’s products, services, processes and systems.
• Ability to organize and prioritize multiple tasks.
• Ability to work in a team oriented environment.
• Ability to effectively communicate and maintain business relationships with Company personnel, outside resources and customers.
• Ability to comprehend agents’ questions and concerns with regard to claims and to provide correct, courteous answers.
• Ability to learn and use the company’s terminology, procedures and systems.
• Ability to learn and develop skills in the use of department equipment.
• Ability to perform basic and complex mathematical calculations.
• Ability to remain calm and professional during peak periods of activity.
• Ability to work from oral and written communication.
• Ability to maintain confidentiality.
• Ability to assist in other work-related areas as required.

High School or GED required and at least 6 months as an Claims/QC Assistant at Rain and Hail or at least one year of previous underwriting or claims auditing experience or a baccalaureate degree.