Claims Audit Consultant

We are adding to our diverse team of experts and are looking to hire those who are committed to building a culture that enables the creation of innovative solutions for our business units and clients.

The Company

Munich Re Specialty North America provides extensive, specialty property and casualty insurance solutions to customers through select brokers, Managing General Agents, program administrators, cover holders and insurtech partners. Products include: property, casualty, professional liability and other specialty insurance solutions. Our comprehensive, customized solutions are provided by A+ rated carriers and are tailored to clients’ needs. We offer superior service levels, industry-recognized underwriting and claims expertise and innovative approaches to complex and evolving risks.

Munich Re Specialty North America is a description for the insurance business operations of affiliated companies in the Munich Re Group that share a common directive to offer and deliver specialty property and casualty insurance products and services in North America.

Future focused and always one step ahead

The Opportunity

The Claims Audit Consultant will be part of a team that performs compliance audits on domestic TPAs and MGAs utilized by MRS - North America and UK operations for handling liability and property claims under delegated authority agreements. Responsibilities include but are not limited to performing regular audits (including analysis of policies and procedures, execution of audit workpapers, and preparation of audit reports) of TPA and MGA partners. The Claims Audit Consultant collaborates with the Sr. Compliance Consulting Manager to communicate audit results both internally and externally, follows up on issues identified during the audits and subsequent closure, updates internal databases with key details from the audit.

Responsibilities:

• Responsible for performing routine claims compliance audits of TPA and MGA partners, including:
• Conducting remote (or on-site) audits to assess the TPA or MGA claims handling process, procedures and controls.
• Reviewing and analyzing claim files to ensure compliance with relevant laws, regulations and industry standards, including adjuster licensing, regulatory reporting, adherence to anti-fraud requirements, internal controls, information security and privacy administration, management of loss funds, consistent observance of fair claims settlement practices regulations, and handling of consumer complaints.
• Evaluating TPA and MGA compliance with our claim services agreements, identifying and documenting any non-compliance issues or areas for improvement, and completing audit workpapers and reports in a timely manner.
• Communicating audit observations, findings and questions to TPA/MGA Senior Leadership.
• Responsible for kick-off meetings, walkthroughs, and exit meetings for audits conducted throughout the year. Collaborates with the Sr. Compliance Consulting Manager on yearly audit scheduling and planning.
• Conducting follow-up reviews with TPA and MGA partners to ensure that they have implemented corrective action and timelines agreed upon during the audit.
• Communicating results of the follow-up reviews to the Sr. Compliance Consulting Manager and assisting in the reporting of findings to key internal stakeholders.
• Updating internal databases with relevant audit details to ensure accurate audit tracking, action plan follow-up, and reports.
• Participating in as needed TPA and MGA due diligence reviews in relation to new and existing business.
• Responsible for training of additional team members as the team grows as needed.

Job Requirements:

• Bachelor’s degree in Accounting, Finance, Business, or related field required.
• 5+ years professional working experience in claims consulting/audit/process management. The following are preferred fields and backgrounds: internal auditor within financial institutions or insurance fields (claims auditing is a plus), compliance role within a heavily regulated industry (insurance, financial institutions, pharmaceuticals, etc.), public accounting or internal audit consulting.
• CPCU, CIA or IAP certification, or significant progress towards completion of one or more of these designations, is a plus.
• Understanding of insurance regulations, including knowledge of state-specific requirements. Familiarity with industry best practices and emerging trends in insurance compliance.
• Strong analytical and problem-solving skills with the ability to interpret complex regulations.
• Strong written and verbal communication skills to convey audit findings and recommendations clearly and professionally to Senior Leadership stakeholders.
• Meticulous attention to detail to ensure accuracy in audits and compliance assessments.
• Skilled with Microsoft Office including Access, Excel, PowerPoint, and Word.
• Knowledge of Power BI or similar data dashboarding software is a plus.
• Demonstrated ability to contribute to critical projects, initiatives and working on teams.
• Self-motivated with strong organizational and time management skills to prioritize workflow and ensure duties and projects are completed by deadlines.

This position is being offered in several of our office locations, including Princeton, NJ; Philadelphia, PA; and Atlanta, GA.

At Munich Re, we see Diversity, Equity and Inclusion as a solution to the challenges and opportunities all around us. Our goal is to foster an inclusive culture and build a workforce that reflects the customers we serve and the communities in which we live and work. We strive to provide a workplace where all of our colleagues feel respected, valued and empowered to achieve their very best every day. We recruit and develop talent with a focus on providing our customers the most innovative products and services.

We are an equal opportunity employer. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.