Claims Auditor, Home Warranty

Claims Auditor

The purpose of this job is to provide oversight of the claims' submittal process by correctly adjudicating claims to the Terms of Agreement with the service provider. The claims auditor aims to support the organization by controlling cost and providing a fair and timely claims process to both Assurant and the Service Provider. The objective is to bring systematic, disciplined processes to evaluate and improve the effectiveness of risk management and controls.

Job Responsibilities

• Identify and adjudicate negligent, fraudulent, or inappropriate claims by analyzing the content of claims captured systematically in various audit panels and queues. This also requires frequent customer audits. Includes overseeing team shared email box, team chat, and similar on rotation, and managing multiple email queues.
• Ownership and responsibility for specific audit queues or panels.
• Conduct individual and batch claims research to determine if claimed amounts meet company and / or business rules. Identify specific patterns of behavior and report to management with correction action plans, including specific types of agreement violations, specific vendor issues, specific brands, or model issues. Identify agent or vendor training needs specifically focused on reducing claim errors or negligent claims and provide management with a plan on how to address.
• Makes decisions on claim payments, complex claims issues are reviewed with senior claims auditor or management.
• Performs work that is varied and somewhat difficult in nature. Selects from a variety of established procedures to accomplish assigned tasks.
• Works under supervision.
• Limited analysis of historical claims associated with trends or patterns identified in various audit panels.

Basic Qualifications

Preferred Skills