Claims Quality Assurance Manager

MSIG US continues to grow! 

MSIG USA’s Claims Quality Assurance Manager will be responsible for the technical claims audits for the Claims Department. Claims technical audits are conducted to ensure accuracy, compliance with company guidelines, and adherence to legal and regulatory requirements. The role involves audits of both internal staff and TPAs, audit claims processes, identifying areas of improvement, and providing actionable recommendations to enhance efficiency and effectiveness within the claims department. The ideal candidate will have experience in property and casualty insurance, a strong understanding of multiple lines of business, and excellent organizational and analytical skills.

Key Responsibilities:

Claims Audit & Review:

• Schedule and coordinate audits of internal staff and Third Party Administrators (TPAs).
• Conduct or oversee audits of claims files, including, but not limited to, general liability, professional liability, auto liability, property, financial lines, cyber, among others.
• Verify the accuracy of claims handling, including coverage determinations, liability assessments, and settlement processes.
• Audits identify whether claims are handled in compliance with company policies, industry standards, and regulatory requirements. 
• Manage relationships with external auditing firm(s) and consultants that are utilized as resources to complete annual audit requirements. 
• Review claims for adherence to state and federal regulations, including statutes of limitation and bad faith handling laws.
• Monitor compliance with internal and external audit standards, including data accuracy and documentation completeness.
• Provide recommendations to ensure claims practices are aligned with evolving legal and regulatory frameworks.
• Identify trends and recurring issues within the claims handling process and recommend improvements to increase accuracy, efficiency, and service levels.
• Collaborate with claims adjusters and managers to address deficiencies and ensure corrective actions are implemented.
• Assist in the development and refinement of claims audit procedures, standards, and reporting metrics.
• Prepare detailed audit reports outlining findings, trends, and areas for improvement.
• Present audit results and recommendations to senior management and the claims department.
• Maintain accurate records of audit results, action plans, and follow-up reviews

Qualifications:

• Bachelor’s degree.
• 5+ years of experience in property and casualty insurance with a focus on claims.
• Previous claims auditing or quality assurance experience is highly preferred.
• Industry certifications such as CPCU (Chartered Property Casualty Underwriter), AIC (Associate in Claims), or equivalent are a plus.

• Strong knowledge of liability claims handling practices, procedures, and applicable laws and regulations.
• Excellent analytical and problem-solving skills with attention to detail.
• Ability to interpret complex claims files and assess the adequacy of coverage, liability determination, and settlements.
• Proficiency in claims management systems and audit applications.
• Strong communication and presentation skills, with the ability to clearly convey audit findings and recommendations.
• Ability to work independently and manage multiple audit projects simultaneously.

Travel:

• Travel Required – Up to 25%.

It's an exciting time for our company and a great opportunity to join a financially sound and growing global insurance group!  
It is the policy of MSIG-USA to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, MSIG-NA will provide reasonable accommodations for qualified individuals with disabilities.