Claims Quality Auditor audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Being a Claims Quality Auditor makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Additionally, Claims Quality Auditor typically reports to a supervisor or a manager. The Claims Quality Auditor gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Quality Auditor typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
KEY OBJECTIVE:
As a member of the Property Quality Assurance team, this position is responsible for working collaboratively with business partners to ensure compliance with CHUBB and Industry Best Practices and continuously support the improvement of the technical quality of the claims product, measuring compliance through the completion of quality reviews. This individual will partner with various levels of internal and external claims management to analyze and communicate findings, recommend solutions, and assist in the development of meaningful action plans.
MAJOR DUTIES & RESPONSIBILITIES: