Claims Integrity and Loss Specialist

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Our client, a rapidly growing automotive service contract administration company in Northwest Austin, is seeking a Claims Integrity & Loss Control Specialist to proactively identify fraudulent activity, claim leakage, and process inefficiencies. This role will focus on auditing claims, analyzing trends, and partnering with internal stakeholders to protect financial performance and ensure compliance with company policies. This individual will play a key role in identifying patterns, telling data-driven stories, and driving actionable improvements across the organization. This is a 6 month contract to hire. It is a hybrid role with Monday and Friday being remote days, and the hours are 8-5 with an hour lunch break.

Job Responsibilities:

• Perform detailed audits of claims, including review of repair details, part replacements, photos, and supporting documentation

• Analyze claims data to identify irregular patterns, fraud indicators, and process inefficiencies

• Investigate duplicate submissions, unsupported repairs, and estimate inconsistencies

• Leverage internal data tools and analytics platforms to uncover trends and high-risk behaviors

• Translate findings into clear, actionable insights for risk, sales, and executive teams

• Collaborate cross-functionally to address non-compliant behavior and improve claims processes

• Monitor and improve claims handling procedures and documentation standards

• Assist in building and refining internal audit and fraud detection processes

• Maintain thorough documentation and reporting on findings, trends, and financial impact

Qualifications:

• 3+ years of claims handling, auditing, or investigative experience (2+ years considered for strong candidates)

• Strong understanding of claims lifecycle, contract coverage, and adjudication processes

• Experience reviewing detailed claim components such as part numbers, photos, and repair documentation

• Background in insurance or related claims environments preferred

• Analytical mindset with ability to work with data and identify trends

• Experience with analytics tools such as Tableau, Looker, Sigma, or Power BI preferred

• Strong communication skills with ability to present findings across multiple levels of the organization

• High attention to detail and strong organizational skills

• Ability to manage multiple priorities and adapt in a fast-paced environment

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