Insurance Claims / File Auditor

Claims / File Auditor – NIHL Claims

Job Market – Insurance Claims / Auditing

Claims / File Auditor – About the role

My client are seeking an experienced Claims / File Auditor to support the delivery of technical excellence across our Legacy claims operation.

The successful candidate will undertake detailed technical audits of claims files, providing constructive feedback, mentoring and guidance to claims handling teams. The role will also involve identifying trends, highlighting areas of risk or financial leakage, and supporting the ongoing technical development of Legacy Lawyers and claims professionals.

This is an excellent opportunity for an experienced NIHL claims professional looking to utilise their technical expertise in a quality, audit and development-focused position.

Claims / File Auditor – Key duties

Technical Auditing

• Conduct regular audits of NIHL claims files to assess handling performance against internal technical standards and client requirements.
• Review files to identify incorrect or inappropriate actions, missed opportunities, procedural issues and areas of technical risk.
• Assess compliance with client guidelines and contractual Service Level Agreements (SLAs).
• Identify potential financial leakage and other areas of risk to the business.
• Undertake bespoke and targeted file audits at the request of the Technical Director, Operations Director or Business Unit Director.
• Provide feedback arising from client SLA audits undertaken by other teams.
• Ensure audit activity is completed accurately and within agreed timescales.

Reporting & Recommendations

• Clearly communicate audit findings both verbally and through detailed written reports.
• Provide practical and constructive recommendations for remedial action.
• Prepare timely reports for the Technical Director and Operations Director covering individual, team and unit performance.
• Develop clear and appropriate action plans to address identified issues and improve technical performance.
• Identify recurring issues and trends across audit results and communicate these to relevant stakeholders.

Technical Development & Mentoring

• Provide constructive feedback and mentoring to individual claims handlers and teams.
• Identify common technical trends and areas where additional training or development is required.
• Support the delivery of training and upskilling initiatives where appropriate.
• Contribute to the continual improvement of technical standards and claims-handling practices across Legacy.
• Provide technical input into incident reporting and the resolution of identified quality issues.
• Promote a positive audit culture, ensuring the process is viewed as an opportunity for learning, development and improvement.

Technical Responsibilities

• Review documentation and assess evidence within Military Deafness / NIHL claims.
• Assess the appropriateness of claims strategy and identify potential areas of concern.
• Evaluate whether appropriate investigative actions have been undertaken.
• Review the adequacy and accuracy of claims reserves.
• Understand and assess the application of Ogden calculations within relevant NIHL claims.
• Identify potential technical, financial and procedural risks within claims files.

Claims / File Auditor – Key requirements

• Strong experience of handling NIHL claims.
• Experience managing a NIHL caseload from initial instruction through to conclusion.
• A good understanding of claims strategy, investigation and evidence assessment.
• Experience of reviewing files against technical standards and/or client requirements.
• Strong attention to detail and the ability to identify errors, omissions and potential risks.
• A calm, fair and objective approach when assessing the performance of others.
• Good IT skills and confidence working with claims and reporting systems.
• Hold British Citizenship, or be a dual national where one nationality is British