Case Management Auditor-Personal Injury Cases

Job description:

Job Overview
Join our dynamic team as a Case Management Auditor specializing in Personal Injury Cases! In this vital role, you will lead the review and analysis of personal injury claims, ensuring accuracy, compliance, and integrity throughout the claims process. Your expertise will help optimize case resolution, and uphold regulatory standards. This position offers an exciting opportunity to apply your analytical skills and insurance knowledge in a fast-paced environment dedicated to delivering exceptional service and fairness to clients.

Duties

• Conduct comprehensive audits of personal injury claims to verify accuracy, completeness, and adherence to insurance policies and legal requirements.
• Maintain meticulous records of audit findings, correspondence, and case documentation using financial software and case management systems.
• Audit files for a team of 2–4 Pre-Litigation Case Managers to ensure compliance with firm policies and procedures.
• Conduct weekly one-on-one meetings to review and address file deficiencies.
• Review case files for accuracy, organization, and timely progression from case assignment through settlement.
• Audit liability investigations, insurance coverage, medical treatment, damages, and client communication for completeness and compliance.
• Assess cases for potential surgical intervention and litigation, identifying files that require escalation.
• Ensure critical documents, records, and deadlines are properly obtained, documented, and tracked.
• Monitor treatment gaps, case activity, and overall file progression.
• Identify trends, provide corrective feedback, and recommend process improvements to management.
• Maintain audit reports and ensure corrective actions are completed.
• Experience with salesforce or other case management systems.