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Trisura · 22 hours ago

Auditor Delegated Authority, Claims

Oklahoma City, OK

Full-time

Hybrid

Senior Level, Lead/Staff

10+ years exp

Trisura is a company that provides innovative solutions and expertise in risk management across North America. They are seeking an Auditor for Delegated Authority, Claims, who will be responsible for performing audits of claims administrators, delivering feedback, and ensuring compliance with insurance regulations.

Financial ServicesInsuranceService Industry

Comp. & Benefits

Responsibilities

Audit Performance: Executes detailed and outcome-based audits that include, but also go beyond process compliance, to access the accuracy and adequacy of reserves, the accuracy of coverage determinations, the effectiveness of litigation strategies, and the alignment of claim outcomes with program expectations

Vendor Engagement/Collaboration: Maintains strong relationships with claim administrators to promote a cohesive and effective engagement

Planning & Preparation: Performs analysis of claims data (i.e., dashboard, claims bordereaux, litigation log, etc.) and claims metrics (i.e., complaints, internal/external feedback, etc.) to support effective planning and focused audit testing

Reporting Results: Delivers actionable insights from audit findings in a formal report format, focused on driving continuous improvement in claims outcomes. Coordinates with peers and management for follow-up on any adverse findings to ensure that they are appropriately addressed through to proper resolution/satisfaction. Likewise, identifies risks with TPA’s and appropriately escalates along with recommendations for corrective measures and/or a compensating ongoing monitoring framework

Process Improvement: Supports the ongoing development of the claims audit and performance monitoring value proposition by contributing to the enhancement of procedures, templates, and supporting tools. Likewise, identifies opportunities for process optimization within the Delegated Authority Claims audit framework to enhance efficiency and effectiveness

Travel as needed and/or warranted

Perform other duties as required or assigned which are reasonably within the scope of the duties in this job description

Qualification

Claims management experienceAudit experienceInsurance regulations knowledgeData analyticsClaims management systemsAdjusters LicenseCustomer serviceAnalytical skillsTeam collaborationCommunication skills

Required

Minimum of five (5) years' experience in claims management/supervision with a focus on complex exposures in all lines; claims handling best practices auditing experience considered a plus

Minimum of ten (10) years' experience in direct performance of claims handling specific to commercial and residential property, commercial and personal auto (interstate and intrastate trucking experience considered a plus), and commercial general liability (NY Labor Law, liquor liability, and hospitality experience considered a plus)

Current and in good standing Resident State Adjusters License with P&C lines of authority

Competence in the Microsoft suite of products (specifically, Word and Excel)

Preferred

Bachelor's degree in risk management, business administration, finance, or related field preferred; Insurance industry recognized accreditation considered a plus

Background in oversight and control, knowledge of regulatory environment, legal contracts, and data analytics considered a plus

Software Proficiency: Familiarity with claims management systems (e.g. Duckcreek, Guidewire, FileHander, Virtual Claims Adjuster) considered a plus