Claims Compliance Audit Specialist
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Claims Compliance Audit Specialist at Kin reviewing claims for accuracy and compliance with regulatory requirements. Collaborating with claims and legal teams to improve operational effectiveness.
Responsibilities:
- Conducting technical reviews of claim files and compliance check points to evaluate claim handling, documentation, coverage application, and adherence to company standards and regulatory requirements.
- Analyzing state-specific claims handling requirements and documenting their impact on Claims processes and operations.
- Identifying quality, technical, and compliance trends and translating findings into actionable insights for leadership and stakeholders.
- Executing monitoring and testing of claims compliance controls and recommending improvements where gaps are identified.
- Participating in calibration discussions to ensure consistent interpretation and application of claim handling standards and expectations.
- Contributing to the development and refinement of audit tools, reporting processes, and review standards.
- Collaborating with Training, Claims Leadership, and Automation teams to address identified trends and improve claims handling practices.
- Drafting and updating Standard Operating Procedures and processes based on audit findings, regulatory changes, and business needs.
- Acting as the go-to resource for peers by providing guidance on unique claims scenarios, offering coaching, and contributing to team training and knowledge sharing.
- Supporting the execution of claims compliance projects by coordinating tasks, monitoring progress and risks, and ensuring timely delivery of project milestones and regulatory requirements.
- Managing complex ad hoc audits and reviews from planning through execution, including the evaluation of results, presentation of recommendations, and implementation of changes to enhance Claims department practices.
Requirements:
- 3+ years of claims compliance or 5+ years of claims experience
- A deep understanding of homeowners policies, claim processes and legal and regulatory landscape of the insurance industry
- An ability to proactively identify systemic trends and emerging risks across claim files, providing actionable insights that prevent recurring issues and strengthen compliance practices across multiple teams
- The capability to evaluate claims against established technical and compliance standards while identifying documentation gaps or areas of concern
- Experience in transforming project management into a strategic driver, using data, trend analysis, and performance insights to improve processes, optimize workflows, and prevent recurring issues
- Familiarity in bringing alignment to cross-functional teams, navigating competing priorities, and ensuring seamless execution of complex, high visibility initiatives when working alongside attorneys, stakeholders, and adjusters
- Commitment to maintaining the highest ethical standards in all aspects of claims compliance and operations.
Benefits:
- Competitive salary and company equity through Restricted Stock Units (RSUs), granted as part of our standard compensation package and based on role and level
- 401(k) with company match up to 4% of eligible earnings
- Multiple medical plan options, plus dental and vision coverage
- Company-funded HSA contributions (based on medical plan selection)
- Company-paid life insurance and short-term disability
- A variety of supplemental benefit options, including long-term disability, critical illness, accident, legal, and pet insurance
- Access to mental health support and confidential counseling resources
- Flexible PTO for exempt employees (most employees take 15–20 days per year), plus 8 company-observed holidays
- Paid parental leave, including up to 14 weeks at 100% pay for birthing parents and 8 weeks at 100% pay for non-birthing parents
- Career mobility and internal growth opportunities across the organization
- Professional development budgets for certifications, conferences, and learning available, subject to management approval
Similar Jobs
Senior Enterprise Architect – CLM, Spend Management
Senior Enterprise Architect at Workday guiding customers in AI-augmented contract workflows. Leading strategic technology solutions in Spend Management and CLM.
People Systems Support Specialist
HR Systems Support Specialist supporting HR operations and technology solutions at Wella, including SAP SuccessFactors. Responsible for user support, troubleshooting, and system administration activities.
Audit Manager
Audit Manager for RRBB Accountants + Advisors leading attest engagements and mentoring staff. Ensuring compliance with accounting standards and providing quality assurance in audits and reviews.
IT Help Desk Specialist
IT Help Desk Specialist providing Tier 1-2 support for a remote workforce at TopDog Law. Managing tickets and troubleshooting hardware and software issues in a fast-paced environment.
Help Desk Representative
Provide Tier 1 customer support for health insurance inquiries via phone, chat, and email. Remote work position located within the United States, focusing on agents and state agencies.
Principal Enterprise Architect
Principal Enterprise Architect defining and governing enterprise-wide architecture strategy at IQVIA. Collaborating with business and technology leaders to optimize clinical operations.
IT Help Desk
IT Help Desk role ensuring operational productivity for Addi employees with secure technology infrastructure management. Maintaining a high ticket resolution rate and automating processes for improved efficiency.
IT Manager
IT Manager leading a small team at Longbow Advantage, a B2B SaaS logistics company. Responsible for critical IT functions and operational maturity within the organization.
Pharmacy Benefit Technician
Pharmacy Benefit Technician handling calls regarding pharmacy issues and prior authorizations. Responsible for processing requests and serving as a liaison with pharmacy benefit managers.
Corporate IT Support Specialist
Corporate IT Support Specialist providing first line support for Vultr's remote teams managing IT ticketing and SaaS administration
Enterprise Architect
Enterprise Architect leading multiple complex projects using in-depth domain knowledge at GE Vernova. Contributing to technology development, architecture design, and project management.
Enterprise Architect
Enterprise Architect leading highly complex projects that require in-depth domain knowledge. Focusing on project and data delivery platforms and future architecture direction.
Senior IT Engineer – MSP
Senior IT Engineer providing expert support across systems, servers, and cloud environments. Collaborating with clients and mentoring junior engineers in a fully remote setup.
Technical Customer Support Specialist
Technical Customer Support Specialist providing support for Bold Group's Financial Management solutions. Monitoring ticketing queues and solving technical issues for customers in diverse environments.
IT Manager
IT Manager overseeing daily IT operations for government contracting organization in cloud environment. Responsible for user support, compliance, and endpoint management.
Enterprise Architect
Lead Enterprise Architect at Concept Plus designing and implementing IT systems. Collaborating with clients and engineers, guiding teams, and optimizing enterprise architecture.
Audit Specialist
Audit Specialist coordinating departmental audits at Blue Cross NC. Identifying errors, formulating recommendations, and supporting quality assurance initiatives.
IT Help Desk Specialist
IT Help Desk Specialist providing technical assistance to end-users across the organization. Troubleshooting software issues and maintaining IT systems remotely during US business hours.
Senior Enterprise Architect – EHR
Sr. Enterprise Architect Principal providing technical leadership and architectural oversight in EHR systems for GDIT. Guiding integration, performance, and security across enterprise EHR services.
Senior IT Manager
Senior IT Manager building and overseeing IT operations at Givebutter, a nonprofit fundraising platform. Seeking hands-on leader to establish structure and support scalability.