Claims/QC Auditor

Job Title: Claims/QC Auditor

Department: Claims

Reports to: Office Manager

Classification: Non-Exempt

Purpose: Audit claims to assure accurate and timely payment and to test the work product of claims adjusters.

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.

Job Qualifications

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.