Overview:
Our client, a respected insurance carrier, is seeking an experienced Claims Auditor to join their team. This role is responsible for conducting comprehensive audits of claims files to ensure compliance with company guidelines, regulatory standards, and industry best practices. The ideal candidate will have prior experience auditing Commercial Auto, Workers’ Compensation, or Financial Lines claims and a strong understanding of claims handling procedures.

This position plays a key role in maintaining quality standards, identifying operational improvements, and supporting continuous improvement initiatives within the claims department.

Compensation:

• $100,000 - $130,000/year (based on experience)
• Annual bonus potential
• Full medical benefits
• Lucrative 401k with company match

Responsibilities

• Conduct detailed audits of claims files across Commercial Auto, Workers’ Compensation, and/or Financial Lines lines of business.
• Evaluate claims handling practices to ensure compliance with internal guidelines, regulatory requirements, and industry standards.
• Review claim documentation, reserving practices, coverage determinations, and settlement strategies for accuracy and completeness.
• Identify trends, inconsistencies, and areas for improvement within the claims handling process.
• Prepare detailed audit reports outlining findings, recommendations, and corrective actions.
• Collaborate with claims leadership and adjusters to provide feedback and support best practices in claims management.
• Participate in quality assurance initiatives and help develop procedures to improve claims outcomes and operational efficiency.
• Track and monitor follow-up actions related to audit findings to ensure resolution and compliance.

Requirements

• 5+ years of insurance claims experience, with a focus on Commercial Auto, Workers’ Compensation, or Financial Lines.
• Prior claims auditing or quality assurance experience strongly preferred.
• Strong knowledge of claims handling procedures, coverage analysis, reserving practices, and regulatory requirements.
• Excellent analytical and investigative skills with strong attention to detail.
• Ability to review large volumes of claims files and identify trends or areas of risk.
• Strong written and verbal communication skills, including the ability to present audit findings clearly and constructively.
• Proficiency with claims management systems and Microsoft Office applications.

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Casualty Analyst – Specialty Claims

Job Summary

Seeking a highly skilled and motivated Casualty Analyst – Specialty Claims to join a dedicated team. This role focuses on providing high-level technical expertise in the handling of complex commercial umbrella, excess liability, and multi-party catastrophic injury claims. The ideal candidate will have a strong background in managing high-exposure liability claims and a commitment to achieving optimal outcomes for both the company and its policyholders.

Compensation Package

• Salary Range: $85,000 - $115,000 annually + annual bonus opportunities based on company and individual performance
• Competitive benefits package, paid time off, professional development opportunities, etc.

Responsibilities

• Build and maintain strong relationships with internal staff, policyholders, attorneys, agents, and service providers to achieve optimal claim outcomes.
• Provide high-level technical expertise in managing complex and high-exposure liability and extra-contractual claims.
• Handle a portfolio of complex claims, including commercial umbrella, excess liability, and multi-party catastrophic injury claims.
• Stay updated on case law developments, statutory, and regulatory changes impacting liability claims or coverage interpretation.
• Serve as a training and information resource for casualty and litigation claim representatives and claim management.
• Oversee all claim-handling activities, including investigation, litigation management, evaluation, settlement negotiations, and risk transfer guidance.
• Prepare and present claims to the Large Loss Committee and ensure proper reinsurance reporting and communication.

Qualifications/Requirements

• Minimum of 5+ years of experience handling complex claims.
• Bachelor’s degree or equivalent work experience.
• Strong technical expertise in liability claims and coverage interpretation.
• Excellent communication and relationship-building skills.
• Ability to work effectively in a hybrid work environment, with 8 in-office days per month.

#LI-BR1

Technical Claims Director, Property & Casualty

Job Summary

Seeking a highly skilled and experienced Technical Claims Director, Property & Casualty to join a growing Claims Compliance and Quality Assurance team. This is a critical role for an accomplished insurance claims compliance professional or attorney with deep knowledge of insurance claims regulations, processes, and technology. You will play a pivotal role in safeguarding the organization from regulatory risks, ensuring compliance, and driving continuous improvement in claims handling practices.

Compensation Package

• Salary Range: $130,000 - $180,000 per year (based on experience and qualifications).
• Competitive benefits package, 401(k), paid time off, professional development opportunities, etc.

Responsibilities

As the Technical Claims Director, you will:

• Manage and maintain a 50-state claims database.
• Monitor legislation, DOI bulletins, court decisions, and statutory changes; manage backlog and implement targeted compliance training.
• Develop and oversee controls related to Medicare, OFAC, Child Support Lien Network, and other federal protocols.
• Collaborate with Claims Technical, Legal, and IT teams to design controls and workflows aligned with regulatory requirements.
• Lead responses to regulatory inquiries and complaints.
• Deliver training and provide legal support to internal teams and vendors.
• Develop audit programs and dashboards to monitor compliance effectiveness.
• Oversee and support technology-related compliance integrations.
• Provide executive reporting, trends analysis, and regulatory insights.

Qualifications/Requirements

• 10+ years of experience in claims compliance, insurance regulation, or legal operations.
• A degree in law, risk management, or a related field is required; J.D. is highly preferred.
• Advanced insurance compliance certifications (e.g., CPCU, CIPP, CAMS, CRCM) are a plus.
• Strong understanding of claims handling regulations, Medicare protocols, and market conduct standards.
• Experience managing compliance in a 50-state claims environment across multiple lines of business.
• Knowledge of Medicare Secondary Payer requirements and Section 111 reporting.
• Strong research and policy writing skills.
• Excellent collaboration, project management, and problem-solving abilities.
• Experience with regulatory audit preparation and response.

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