Claims Risk Manager Jobs in Boca Raton, FL (NOW HIRING)

Claims Trainer / Auditor – Non-Standard Auto

Position Summary

Pearl Holding Group is seeking a dynamic and experienced Claims Trainer / Auditor specializing in Non-Standard Auto to join our growing claims operation in Coral Springs, Florida. This is a newly created, on-site position that will play a pivotal role in shaping and elevating the future of our claims department. The successful candidate will serve as a subject matter expert and change agent, responsible for building and delivering training programs, conducting file audits, and driving continuous improvement in claims handling quality and compliance across our non-standard auto book of business.

Location: Coral Springs, FL

Classification: Exempt

Position type and expected hours of work: Full-time; Monday through Friday, standard business hours (8:00 AM – 5:00 PM). This is an on-site position located in Coral Springs, FL. Occasional overtime may be required based on departmental needs and project deadlines.

Reports to: Vice President of Claims / Assistant Vice President of Claims

Essential Duties and Functions

The essential functions include, but are not limited to the following:

• Design, develop, and deliver comprehensive training programs for non-standard auto claims adjusters covering coverage interpretation, liability assessment, damage evaluation, and regulatory compliance.
• Conduct regular file audits across non-standard auto claim types (BI, PD, PIP, COMP, COLL) to evaluate accuracy, coverage application, reserves adequacy, documentation quality, and adherence to best practices and state regulations.
• Identify skill gaps, performance trends, and compliance deficiencies through audit results; translate findings into targeted training interventions and coaching plans for individual adjusters and teams.
• Partner with claims leadership to establish and maintain quality assurance standards, audit scorecards, and KPI frameworks that support departmental goals for accuracy, cycle time, customer satisfaction, and severity management.
• Create and maintain training materials including onboarding curricula, reference guides, e-learning modules, job aids, and process documentation tailored to non-standard auto claims operations.
• Serve as the departmental subject matter expert (SME) for non-standard auto coverage, claims handling procedures, and applicable state statutes; provide guidance and mentorship to adjusters on complex or escalated claims.
• Collaborate with operations, compliance, and IT/systems teams to ensure training content reflects current workflows, system updates, and regulatory changes; support Guidewire Claims system adoption and proficiency across the department.
• Prepare and present audit findings, training completion metrics, and quality trend reports to claims management on a regular basis to inform strategic decisions.
• Support the onboarding and integration of new claims staff by delivering structured orientation training and providing ongoing mentorship through their first 90 days.
• Monitor industry developments, regulatory updates, and emerging claims trends in non-standard auto insurance to ensure training content remains current and competitive.

Minimum Qualifications (Education, Knowledge, Skills, and Responsibilities)

• Minimum of 5 years of experience handling non-standard auto insurance claims, with demonstrated proficiency across multiple coverage types including Bodily Injury (BI), Property Damage (PD), PIP, Comprehensive, and Collision.
• Strong working knowledge of non-standard auto policy forms, endorsements, exclusions, and the unique complexities of high-risk and non-admitted markets.
• Proven experience in claims training, quality assurance, or auditing, with the ability to translate technical expertise into effective, accessible learning experiences for adjusters at all levels.
• Solid understanding of instructional design principles and adult learning theory; experience developing structured training curricula, e-learning content, and competency-based assessment tools.
• Familiarity with Florida insurance regulations and statutory requirements relevant to auto claims, including PIP statutes (§627.736), bad faith standards, and prompt payment obligations.
• Excellent written and verbal communication skills; ability to deliver effective presentations and training sessions to diverse audiences including front-line adjusters, supervisors, and senior leadership.
• Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and claims management systems; ability to quickly learn and train others on proprietary platforms.
• High degree of analytical thinking and attention to detail; ability to identify trends, draw meaningful conclusions from audit data, and present actionable recommendations.
• Bachelor’s degree in Business, Risk Management, Insurance, or a related field; or equivalent combination of education and professional experience preferred.

Preferred Education and Experience: 

• Experience with the Guidewire ClaimCenter or Insurance Now platform, including claim intake, diary management, reserves, payments, and reporting functions; ability to serve as a departmental Guidewire resource and trainer.
• Prior experience in a hybrid SME/trainer/auditor role within an insurance carrier or third-party administrator (TPA) environment.
• Relevant professional designations such as AIC (Associate in Claims), CPCU, or SCLA are a plus.
• Experience using CCC estimating and/or valuation platforms in a claims training or audit capacity.
• Formal training in instructional design methodologies (e.g., ADDIE, SAM) or a certification in learning and development (e.g., ATD CPLP/CPTD).
• Active Florida Adjuster’s License (6-20 or 7-20) required; or willingness to obtain within 90 days of hire.