Claims Auditor

🕒 June 4

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Pro Global

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1993

💳 Fintech

📋 Compliance

Insurance • Fintech • Compliance

Pro Global is a leading provider of global MGA solutions, specializing in transforming and innovating insurance operations through technology and automation. Their team of experts offers a wide range of services including compliance assurance, audit services, broker services, claims management, digital services, and financial and technical accounting. Pro Global partners with insurers, reinsurers, brokers, and InsurTech companies to enhance operational efficiency and compliance.

📋 Description

• Manage multiple audit engagements and lifecycles at one time: overseeing the entire audit process including compiling data from third-party administrator on claims handling structure and requesting information in preparation for the audit. • Audit Third-Party Administrators and Client Claims Teams to ensure adherence to contractual agreements, SLAs, industry standards, and regulatory requirements. • Review pre audit questionnaire (PAQ) responses and necessary documentation; drafting follow-up questions and inquiries as needed. • Manage communication, preparatory, onsite/remote, wrap up, meeting, and post audit/reporting activities. • Analyze claims data to identify trends, exposures, and comparing to best practices. • Evaluate any liability or coverage decisions to evidence appropriate claims handling decisions . • Write professional, detailed reports and appendices; if required or if significant issues identified, prepare the initial summary assessment of findings for client. • Liaise with Audit Administrator regarding audit preparations and MGA/Coverholder/TPA readiness. • Refer to Peer Reviewer before releasing to client.

🎯 Requirements

• Minimum of 5 years insurance claims experience is required with a demonstrable track record of auditing and business and client relationship development. • Bachelor’s degree in business administration or similar field. • Must have successfully completed one or more of the educational programs through the Insurance Institute of America or the Professional Insurance Agents, such as, Chartered Property Casualty Underwriter (CPCU), Program in General Insurance, Associate in Claims (AIC), etc. • Equivalent education, work experience, knowledge, and skills may qualify. • Excellent working knowledge of insurance claims; having experience reviewing claims being submitted to our clients. • Highly structured and conceptual mindset coupled with strong quantitative and analytical problem-solving aptitude. • Excellent written and oral communication skills. • Detail orientated, with excellent organizational and planning skills. • Ability to work independently, with a team, and with initiative is essential. • Ability to travel within the USA up to 10% of the time.

🏖️ Benefits

• PRO IS, Inc. is a subsidiary of Pro Global Insurance Solutions (www.pro-global.com). • Pro Global is a global service provider and consulting company focused solely on the insurance and reinsurance industries. • We provide our clients with cost-efficient, round-the-clock-services.