Claims Compliance Audit Specialist

📋 Description

• • Conduct technical reviews of claim files to evaluate adherence to company standards, regulatory requirements, and proper application of homeowners policy coverage.
• • Analyze state-specific claims handling regulations and document their operational impact on claims processes across multiple jurisdictions.
• • Execute monitoring and testing of claims compliance controls, identifying gaps and recommending process improvements to strengthen regulatory alignment.
• • Identify systemic trends and emerging risks within claim files, translating findings into actionable insights for leadership, Claims, Legal, and Compliance teams.
• • Participate in calibration sessions to ensure consistent interpretation and application of claim handling standards among adjusters and claims teams.
• • Develop, refine, and update Standard Operating Procedures (SOPs) based on audit findings, regulatory changes, and evolving business needs.
• • Collaborate with Training, Automation, and Claims Leadership teams to implement improvements that enhance claim handling accuracy and operational efficiency.
• • Design and enhance audit tools, reporting frameworks, and review standards to improve scalability and consistency of compliance monitoring.
• • Manage end-to-end execution of complex ad hoc audits, including planning, data analysis, recommendation development, and implementation of corrective actions.
• • Serve as a subject matter expert and resource for peers, providing coaching on nuanced claims scenarios and contributing to team training and knowledge-sharing initiatives.
• • Support cross-functional compliance projects by coordinating tasks, tracking milestones, managing risks, and ensuring timely delivery of regulatory deliverables.
• • Champion a culture of continuous improvement by mentoring peers, identifying professional development opportunities, and helping refine training resources and mentorship programs.
• • Actively contribute to the evolution of Kin’s claims compliance framework by integrating data-driven insights, automation opportunities, and feedback from frontline teams.
• • Maintain strict ethical standards in all compliance activities, ensuring integrity, confidentiality, and accountability in every audit and review conducted.
• • Balance competing priorities across Legal, Claims, and Technology teams to ensure seamless execution of high-visibility compliance initiatives with minimal disruption to operations.
• • Evaluate documentation quality in claim files, pinpointing deficiencies in coverage justification, loss estimation, reserve setting, and claims decisioning.
• • Translate regulatory requirements into clear operational guidance for claims teams, ensuring alignment between legal obligations and day-to-day workflows.
• • Proactively anticipate compliance risks before they escalate, leveraging trend analysis to prevent recurrence of systemic issues across regions and teams.
• • Drive process optimization by applying project management rigor to compliance initiatives, using performance metrics and data insights to prioritize and validate improvements.
• • Partner with Automation teams to identify opportunities for embedding compliance checks into claims workflows through technology and AI-enabled tools.