Validates control design and effectiveness and identifies process deficiencies by testing performance of control against Company procedures and/or external regulatory or accounting requirements; evaluating process efficiencies; and performing data and analytical analysis.
Communicates audit findings to customer and audit management team by producing audit documents and work papers; documenting work papers, findings, and recommendations for Management review and presentations; participating in Customer conferences; and assisting with resolving Customer and team issues.
Analyzes strengths and weaknesses of individual and team quality performance results and state claim adjustment regulations compliance by auditing the work of all levels of claims adjusters to ensure regulatory compliance and quality service; determining training and communication gaps and making recommendation for improvements in adjuster training and communications; and developing recommendations for system enhancements to improve process automation and regulatory compliance.
Manages complex claims involving bodily injury, personal injury, and property damage or workers' compensation cases by reviewing, documenting, and indexing claim information within the claim management system; verifying accident information; independently investigating claims, verifying damage or injury; assessing injuries; analyzing evidence and reports; reviewing claim investigation finding for potential fraudulent claims or extenuating circumstances; interacting with claimant; assisting with assignment of outside legal counsel; determining coverage eligibility; establishing claim accrual and payment reserves; reviewing and approving or denying medical services; negotiating and authorizing settlements within authority; preparing claim report, summary of claim, and plan of action for outstanding claims; notifying senior management.
Performs regulatory compliance test work by coordinating with process owners to identify and test controls; validating process documentation; analyzing information technology and business information to identify improvement opportunities; and working with external auditors to test company's regulatory compliance controls.
Minimum Qualifications...Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Minimum Qualifications: Bachelor’s degree in Accounting, Finance, Computer Science, Information Systems, or related field OR 2 years’ experience in internal/external audit, management information systems, information technology, or related area.
Preferred Qualifications...Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.