Manager, Claim Compliance

RLI Corp   •  

Peoria, IL

Industry: Finance & Insurance


5 - 7 years

Posted 32 days ago

Job Description

RLI is hiring a Manager, Claim Compliance to be responsible for full-time auditing of Claim department personnel, policies, and claims to ensure adherence to Best Practices and to report any leakage or internal/external fraud. This position can be based in our Peoria, IL home office or one of our branch locations.

Other key responsibilities of this position will include:

-Develop and implement procedures and automated tools to prevent leakage and detect potential fraud.

-Develop and present training programs to claim personnel re fraud detection and avoiding leakage gaps.

-Compliance oversight for 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 CCO, VPs and AVP, Claim Operations re (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.

Required Skills

-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 5+ years of direct Transportation/Auto claim handling experience, as well as 5+ years of audit and compliance oversight.