CLAIMS AUDITOR

CLAIMS AUDITOR

Administrative Sarasota, FL |

ABOUT PRISM PRISM

is devoted to modernization and innovation within the world of technology, security, and IT enterprise solutions. We are recognized for meeting performance requirements and exceeding customer expectations since 1994. Our culture is founded on relationships, opportunity, and success. Offering comprehensive benefit plans including medical, dental, vision, and 401K along with our people - first approach sustains our reputation as a premier employer. PRISM Inc. is seeking a Claims Auditor who ensures operational excellence by reviewing claim files for compliance, accuracy, and quality. This role identifies handling deficiencies, documents findings, and recommends strategic improvements to enhance effectiveness. Working closely with Claims Leadership, you will serve as a key driver in maintaining consistent, compliant, and high-quality claims practices across the organization.

KEY RESPONSIBILITES

File Auditing:

Perform comprehensive audits to assess adherence to internal policies, state regulations, and claims-handling standards.

Quality Evaluation:

Review coverage analysis, reserving, and settlement activities for accuracy and technical completeness.

Risk Identification:

Pinpoint procedural gaps and compliance risks; analyze trends to recommend corrective actions and performance improvements.

Reporting:

Prepare detailed audit findings and communicate results clearly to Claims Leadership.

Compliance Support:

Participate in DOI and reinsurer reviews while ensuring strict adherence to documentation retention requirements.

Strategic Growth:

Support audit planning and file selection; contribute to staff training initiatives based on audit outcomes.

REQUIRED QUALIFICATIONS

(Skills/Education)

Education:

Bachelor's degree in Business, Insurance, or Risk Management preferred.

Experience:

5+ years in P&C claims handling, QA, or auditing; Property/Liability and CAT experience a plus.

Expertise:

Deep knowledge of policy interpretation, coverage analysis, and industry best practices.

Systems:

Proficient in claims management software and specialized audit tools. PRISM is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.