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.