Claim Manager in Audit and Compliance

RLI is a specialty insurance company that helps customers navigate the world of insurance and risk. For half a century, we've been helping people and companies safeguard their assets through our innovative portfolio of property and casualty coverages and surety products.

* Dedicated fulltime auditing of Claim Department personnel, policies and claims to ensure adherence to Best Practices and to report any leakage or internal/external fraud, with emphasis on Transportation and Auto product lines. * Develop and implement procedures and automated tools to prevent leakage and detect potential fraud. * Develop and present training programs to claim personnel on fraud detection and avoiding leakage gaps. * Compliance oversight re SOX controls and testing, adjustor licensing, Fair Claim Practice procedures, Medicare secondary payer requirements, deductible billing, etc. * Conduct quarterly claim audits of (1) outside vendors and (2) open/closed claims on a continuous basis. * Provide quarterly reports to the Claim VP on (1) results of audits completed in the quarter and resulting Action Plans, (2) audits planned for the next quarter, and (3) recommended enhancements (automated, procedural, training, etc.) to prevent leakage and internal/external fraud.

Extensive experience in audit and compliance duties, fraud detection and leakage prevention. Experience in direct handling of Commercial Auto claims. Knowledge of Fair Claim Practice regulations. Superior analytic and communication skills. **Required Experience** * B.A. plus 10+ years of direct Transportation/Auto claim handling experience, as well as 5+ years of audit and compliance oversight.