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The Director of Claims Auditing and Compliance is a member of Topa’s extended executive team. The position requires the ability to communicate effectively with executives, management and other stakeholders, as well as the ability and desire to train and develop Claims staff. The Director of Claims Auditing and Compliance will have department-wide responsibility for legal and regulatory compliance, for ensuring and improving the quality of our work-product (claim files, forms and correspondence), and will be the main liaison between Claims and the Department of Insurance. The Topa Claims Department is poised for growth and we are seeking a seasoned professional who can manage change and be a leader in creating the additional regulatory and compliance framework needed to ensure the successful operations of an expanding Claims department.
Responsible for claims quality audits of Third-Party Administrators (TPA’s) and internal claims through reviews of open and closed files, providing analytical reports to management with financial and qualitative data. Ensures compliance with the Department of Insurance requirements of all states in which the company writes business and will be the primary contact for the Department of Insurance. Conducts training in accordance with DOI requirements, as well as arranging for claims technical training.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform certain duties including the following in a satisfactory manner. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Directly manages the internal and external claims and compliance audits and is responsible for managing the relationships with all TPA’s and remote locations. Supervises the claims operations of all TPA’s and remote locations. Carries out management responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems, and terminating employees. Must meet or exceed company and departmental objectives on a regular basis in all areas of responsibility.
The requirements listed below are representative of the knowledge, skill, and/or ability required to perform this job successfully.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Topa Insurance Company is a growing boutique specialty insurance carrier in Calabasas, California, with more than 30 years of service in the industry. Our highly engaged employees enjoy a modern, collaborative work environment with on-site fitness. Our top notch management team encourages professional development and achievement, with a commitment to make Topa Insurance an employer of choice. We embrace diversity, believe in, recognize and celebrate our people. Our values of respect, integrity, community, accountability and innovation drive our team. We offer a variety of flexible work schedules and shared incentives built around corporate goals and objectives. Our comprehensive benefits plan includes up to 20 PTO days a year for first year team members, as well as annual time off for charitable activity. We want innovative team members who are eager to excel to join our team.