Program Services Audit - Claims

POSITION SUMMARY: 

The Program Services Audit – Claims position performs claim audits of Trean’s partners as well the direct business of Trean’s carriers. This position will conduct both electronic and on-site audits of the claim files and processes of our partners

• RESPONSIBILITIES: - Plan and schedule claim audits for all assigned Programs.

• Audits include adherence to guidelines, including accuracy, consistency and compliance.
• Assists in developing effective follow-up procedures, systems and management reports that will ensure Program Partners’ and/or TPA’s compliance to audit findings and recommendations. 
• Reporting of claims to reinsurers/reinsurance broker that meet reporting criteria.
• Plan and schedule audit wrap meetings as required on any assigned Programs. 
• Work with our partners if they have specific claim questions 
• Assists in providing claims data and analysis to our independent actuary
• Research industry claim issues and make recommendations to update our claims best practices.
• Representation of Trean with Industry Groups (SAWCA, WCI, etc.)
• Approximately 35% travel required.
• Perform other activities, duties and assignments as needed or requested
• Eligible for remote or hybrid work arrangement