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Claims/QC Auditor in Raleigh, NC at Chubb Group of Insurance Companies

Date Posted: 6/13/2018

Job Snapshot

Job Description

Job Title:              Claims/QC Auditor
Department:         Claims
Reports to:           Office Manager
Classification:      Non-Exempt
Purpose:             Audit claims to assure accurate and timely payment and to test the work product of claims adjusters.
Essential Job Duties and Responsibilities:
  • Performs claims auditing functions, including but not limited to:
    • Opening claims, assigning claim numbers, entering claims data into computer, etc. in a timely manner.
    • Checking losses to ensure that all supporting documentation is included and auditing claims according to established guidelines.
    • Entering loss information on computer system.
    • Confirming accuracy of information against error listings and corrects errors.
    • Referring problem files to appropriate supervisor or manager.
    • Answer questions from adjusters, agents, field staff, and insures about claim status and procedures.
    • Generating and distributing various reports, such as claim forms, claim progress reports, and loss drafts.
  • Performs various quality control functions, including but not limited to:
    • Generating quality control documents, reports and distributing as directed. 
    • Entering completed quality control reviews on computer system.
    • Informing appropriate staff of the review process and results.
    • Making changes in policies as necessary to reflect QC audit results.
    • Maintaining records of agent and adjuster training hours as necessary.
  • Assist with other duties as necessary.
Knowledge, Skills, and Abilities
  • Ability to learn and apply detailed information about the Company’s products, services, processes and systems.
  • Ability to organize and prioritize multiple tasks.
  • Ability to work in a team oriented environment.
  • Ability to effectively communicate and maintain business relationships with Company personnel, outside resources and customers.
  • Ability to comprehend agents’ questions and concerns with regard to claims and to provide correct, courteous answers.
  • Ability to learn and use the company’s terminology, procedures and systems.
  • Ability to learn and develop skills in the use of department equipment.
  • Ability to perform basic and complex mathematical calculations.
  • Ability to remain calm and professional during peak periods of activity.
  • Ability to work from oral and written communication.
  • Ability to maintain confidentiality.
  • Ability to assist in other work-related areas as required.
Job Qualifications
High School or GED required and at least 6 months as an Claims/QC Assistant at Rain and Hail or at least one year of previous underwriting or claims auditing experience or a baccalaureate degree.

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