Delegated Claims Audit Specialist - General LIability/Auto/Property

Position Summary

The General Liability / Auto / Property Delegated Claims Audit Specialist conducts comprehensive audits of multi-line casualty and property claims — including general liability, auto liability, auto physical damage, and first-party/third-party property — administered under delegated authority by third-party administrators (TPAs) on behalf of the company and its insureds/clients. The role evaluates the quality, accuracy, compliance, and financial integrity of delegated claim handling to ensure adherence to company guidelines, client service instructions, policy provisions, and industry best practices, supporting loss-cost control and TPA performance management.

Key Responsibilities

• Perform file-level and program-level audits of GL, auto, and property claims handled under delegated authority by TPAs, applying standardized scoring criteria and audit protocols.

• Evaluate coverage analysis and coverage decisions, including policy interpretation, reservation-of-rights handling, and coverage position documentation.

• Assess liability investigation quality, liability assessment/comparative negligence analysis, and timeliness of contacts and decisions.

• Review damages evaluation, including bodily injury valuation, special/general damages support, and property damage estimating/appraisal.

• Evaluate reserve adequacy, reserve rationale, and timeliness of reserve adjustments relative to exposure.

• Audit property claim handling — scope of damage, estimating accuracy, ALE/business interruption where applicable, depreciation/ACV-RCV treatment, and vendor management.

• Review litigation management, defense counsel oversight, litigation budgets/plans, and settlement authority compliance.

• Assess subrogation/recovery identification and pursuit, including salvage handling.

• Identify fraud indicators and evaluate appropriateness of SIU referrals.

• Verify Medicare compliance for liability/no-fault claims, including Section 111 reporting and conditional payment/MSP considerations where applicable.

• Confirm adherence to delegated authority limits, claim handling guidelines, and escalation/reporting requirements.

• Document audit results in clear written reports with scoring, root-cause analysis, and actionable corrective recommendations.

• Track remediation, validate corrective actions, and conduct re-audits as needed.

• Identify trends and systemic handling issues across files; report findings to leadership and contribute to TPA scorecards and stewardship reviews.

• Support new TPA onboarding/baseline audits, catastrophe-response audits, and client-driven special audits.

Required Qualifications

• 5+ years of multi-line casualty and/or property claims adjusting and/or claims audit experience (GL, auto, property).

• Strong understanding of coverage analysis, liability assessment, damages/BI evaluation, property estimating, and reserving methodology.

• Familiarity with litigation and settlement practices and recovery/subrogation processes.

• Adjuster license(s) as required by applicable jurisdictions (or ability to obtain).

• Proficiency with claims and estimating systems (e.g., Xactimate familiarity a plus) and Microsoft Office (Excel, Word).

Preferred Qualifications

• Bachelor’s degree.

• Professional designations such as AIC/AIC-M, SCLA, AINS, ARM, or CPCU.

• Prior experience auditing TPAs or working within a carrier/self-insured delegated claims oversight function.

• Multi-jurisdictional handling experience and exposure to commercial and personal lines.

Core Competencies

• Strong analytical and critical-thinking skills with high attention to detail.

• Excellent written communication; able to produce clear, defensible audit reports.

• Sound judgment and objectivity; comfortable delivering constructive findings.

• Ability to manage multiple audits independently and meet deadlines.

• Professionalism and tact in interactions with TPAs, clients, and internal stakeholders.