Claim Auditor

Essential Job Functions

• Perform detailed audits of loss reports and call interactions for all examiners, identifying discrepancies, operational opportunities, and quality concerns
• Evaluate claim handling and call performance through a structured scoring system; document results and deliver clear, actionable feedback to employees verbally and/or in writing
• Facilitate coaching sessions with examiners to ensure all quality and customer service standards across both claims processing and call handling
• Work directly with the training team to create and develop ongoing training materials and skill refinement plans for the department based on audit and call QA results
• Participate in calibration sessions with examiners and department leadership to ensure consistency in audit and call QA scoring
• Track and analyze performance results for monthly scorecards, department KPIs, and call quality metrics
• Serve as a mentor and subject matter resource for the department, offering guidance on claim handling and customer interactions
• Maintain a continual knowledge of products and services to ensure compliance with all regulations
• Identify root causes of recurring issues within claims processes and propose effective solutions to management to mitigate risks

Minimum Qualifications

• Minimum 1-2 years of relevant experience in quality assurance or quality monitoring, within a call center environment
• Minimum 1-2 years customer service call center environment strongly preferred
• Proficiency in desktop MS applications – Outlook, Excel, PowerPoint
• Claims Adjusters License (preferred)
• Effective presentation, planning, and oral and written communication skills
• Works well independently and effectively manages their time to meet all established deadlines
• Must be highly flexible, and able to handle and manage a high degree of change
• Demonstrates a high commitment to quality and has strong attention to detail
• Strong customer service acumen with hyper-focus on the customer experience
• Able to evaluate employee progress to ensure that the business needs of the department are being met.
• Maintain high and consistent production level as assigned