R-111613 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. This is a virtual role requiring candidate to work Monday - Friday. What will be my duties and responsibilities in this job? • 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. What are the requirements needed for this position? • High School Diploma • 2+ years’ experience with claim adjudication, servicer repair service management, or service administration of major electronics, major appliances, or other similar products. Knowledge and demonstrated process improvement skills in claims processing and auditing • Working knowledge of Service Repair Industry, claim processing environments and team collaboration • Problem solving skills, with attention to detail • Basic Computer skills with Office Software Products • Ability to Multitask • Critical thinking and negotiating skills • Ability to effectively communicate with external and internal team members, clients, and management What other skills/experience would be helpful to have? • Basic knowledge and experience in the use of Microsoft office tools, including Excel, Word, and PowerPoint • Experience in negotiation and decision making independently Apply tot his job