Quality Assurance File Reviewer

Insurance Claims Unlimited Introduction:

Insurance Claims Unlimited (ICU) is a leading provider of claim administration services, primarily across nine Southeastern U.S. states. Our solutions are designed to serve insurance carriers, self-insured entities, risk retention groups and governmental entities. ICU offers a comprehensive range of services, including third-party administration, personal and commercial property claims, casualty claims, catastrophe management, litigated claim management, and alternative dispute resolution (appraisals and mediations). Our mission is to deliver an unparalleled level of service to client partners and their customers, fulfilling promises, and being good stewards of capital.

Position Overview:

The Quality Assurance (QA) File Reviewer plays a crucial role in ensuring that the claims and related reports submitted by field adjusters meet the high standards of Insurance Claims Unlimited (ICU). The QA File Reviewer is responsible for thoroughly reviewing field adjuster reports, estimates, and property inspections for accuracy, compliance with carrier policies, and adherence to ICU’s guidelines. The position requires strong attention to detail, extensive knowledge of insurance claims processes, and the ability to provide constructive feedback to field adjusters to ensure accurate, complete, and compliant reports. The QA File Reviewer is the final point of contact before claims and reports are sent back to the insurance carriers, ensuring that the final product represents ICU's high standards of service and quality.

Qualifications & Experience:

• Florida All-Lines Adjuster license required.
• Additional U.S. State Adjuster Licenses are a plus.
• 7 years of experience in insurance claims, claims administration, field adjusting, or quality assurance, preferably within property or casualty insurance.
• Extensive experience with claims management software and a strong ability to navigate various claim systems. Familiarity with estimating residential and commercial properties, including platforms like XM8/Xact, Symbility, or similar tools, is a plus.
• Strong background in property claims processes, including reviewing adjuster reports, estimates, and property inspections.
• Previous experience working with third-party administrators (TPAs) or insurance carriers is a plus.
• Previous experience in training or mentoring field adjusters.
• Experience with catastrophe claims or handling claims after large-scale events, such as hurricanes or severe storms, is beneficial.
• Desired qualifications include experience with commercial property claims, flood insurance (NFIP certification), large-loss or high-value property claims, and appraisal experience.

Knowledge, Skills & Abilities:

• Strong knowledge of insurance claim processes and an understanding of property insurance policies, coverage, and terminology.
• Exceptional attention to detail and the ability to identify discrepancies or errors in claims reports and estimates.
• Knowledge of state-specific regulatory requirements related to property insurance and claims management within the U.S.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook, etc.) and the ability to adapt to other software tools as needed.
• Strong communication skills to effectively provide feedback and train field adjusters, and to facilitate communication with clients and carriers.
• Problem-solving skills and the ability to assist adjusters with complex claims and policy coverage issues.
• Ability to manage multiple claims at once, with a strong focus on meeting deadlines and ensuring timely completion of tasks.
• Self-motivated with the ability to work independently and as part of a collaborative team.

Education:

• Bachelor’s Degree in Business Administration, Insurance, or a related field, or equivalent work experience.

Personal Attributes:

• Strong organizational skills, with the ability to manage multiple tasks and priorities effectively.
• High level of professionalism and a commitment to upholding ICU’s service and quality standards.
• Customer-focused approach, ensuring that reports are accurate, clear, and meet client needs.
• Adaptable to changes in processes, regulations, and company policies.
• Proactive and eager to contribute to continuous improvement efforts within the QA process.

This position requires someone who is highly organized, committed to accuracy, and has a deep understanding of the insurance claims process. The ideal candidate will possess a blend of technical expertise, strong communication skills, and the ability to maintain high standards of quality control throughout the claims review process.