Next Insurance

• Own the full premium audit lifecycle for WC and GL lines of business, managing pipelines, backlogs, and reconciliation workflows, while ensuring strict adherence to NCCI, WCIRB, and other state-specific regulatory requirements • Lead, coach, and develop a high-performing organization of managers and QA staff • Spearhead a comprehensive QA program to ensure accuracy in payroll and class codes, utilizing trend analysis to identify systemic errors and lead corrective initiatives • Manage external audit vendors by optimizing assignment strategies and performance standards; partner with Finance on spend analysis, budgeting, and cost-optimization across internal and vendor partners • Continuously enhance the audit customer journey to reduce friction, improve clarity, and increase audit completion rates • Serve as the operational lead for audit system automation, partnering with Engineering, Product, Reporting, and Data Science to define requirements, conduct testing, and deploy AI-centric audit tools and features • Refine and deliver weekly, monthly, and quarterly reporting on production, quality trends, and organizational performance • Act as the owner for state inquiries and internal partners (Underwriting, Reporting, Claims, Compliance) to resolve regulatory escalations and system issues

• Develop and maintain a comprehensive compliance program that aligns with applicable laws, regulations, and industry best practices. • Establish and communicate compliance policies and procedures throughout the organization. • Conduct regular risk assessments to identify compliance gaps and implement corrective measures. • Implement effective compliance monitoring and testing processes to ensure ongoing compliance. • Maintaining and implementing OFAC and AML policies and procedures in accordance with applicable laws and regulations. • Evaluating and fine tuning code of conduct, employee non-disclosures and confidentiality and invention assignment agreements. • Monitor changes in laws, regulations, and industry guidelines and update the compliance program accordingly. • Interpret and communicate the impact of regulatory requirements to relevant stakeholders within the organization. • Ensure compliance with all applicable laws, regulations, and licensing requirements. • Prepare and submit necessary regulatory filings and reports accurately and in a timely manner. • Collaborate with internal teams to address compliance issues and implement remedial actions. • Manage / lead market conduct exams and other regulatory investigations in conjunction with Legal and other areas of the business. • Develop and update compliance policies and procedures to reflect changes in regulations and business practices. • Establish and implement training programs to educate employees on compliance requirements. • Respond to compliance-related inquiries and provide guidance to employees on compliance matters. • Regularly assess the effectiveness of compliance training and make improvements as needed. • Develop and implement monitoring and auditing procedures to ensure ongoing compliance. • Conduct regular compliance assessments and internal audits to identify potential risks and areas for improvement. • Prepare reports on compliance activities, including identified issues, remediation efforts, and compliance metrics. • Provide regular updates to senior management and the General Counsel on the status of compliance initiatives. • Collaborate with internal and external auditors to facilitate compliance audits and reviews.

• Conduct advanced GL audit reviews for both internal and vendor audits, ensuring consistent quality, accuracy, and compliance across all sources. • Validate exposure calculations including sales, payroll (as applicable), subcontractor costs, and construction-related labor, materials, and contract values. • Apply specialized expertise in construction risks (carpentry, remodeling, GC operations, subcontractor structures) and large grocery/retail risks with complex or multi-department operations. • Confirm accurate classification for multi-class businesses, including retail + installation, service + sales, mixed operations, and diverse construction activities. • Ensure supporting documentation (COIs, subcontractor lists, sales ledgers, job summaries, financials) fully reconciles with final exposures. • Review Descriptions of Operations (DOOs) for clarity, completeness, and alignment with exposure and classification determinations—especially for variable risks such as construction and large retail chains. • Identify misclassifications, documentation gaps, unsupported exposure adjustments, and systemic issues; provide clear, actionable corrective guidance. • Create and document risk reviews to highlight key operational changes identified during audit, raising potential policy updates or classification revisions to Underwriting as needed. • Serve as a subject-matter expert (SME) in ISO/GL class codes, construction-related exposures, subcontractor handling, and large multi-department grocery/retail classifications.

• Extensive policy document and legal contract interpretation • Ability to analyze and identify coverage and related coverage issues • Leverage a working knowledge of insurance contracts, Unfair Claims Settlement Practices, insurance codes, civil codes, vehicle codes, arbitration rules and regulations, tort law, claims best practices handling and management as part of your ongoing adjudication of claims • Manage, investigate, and resolve claims within prescribed authority levels • Recommend ultimate resolution on assigned cases in excess of authority to claims management • Rely on a deep background of litigation handling experience in both General Liability and Casualty files to resolve claims • Consistently drive litigation, attend mediations, trials, and other alternative dispute resolution avenues • Communicate with policyholders, witnesses, and claimants in order to gather information regarding claims, refer tasks to auxiliary resources as necessary, and advise as to the proper course of action • Preemptively communicate and respond to various written (email, SMS, fax, mail) and telephone inquiries, including status reports • Present file materials for authority and roundtables • Work with nurses, doctors, and attorneys on file reviews • Comply with all statutory and regulatory requirements of all applicable jurisdiction • Meet detailed quality assurance standards and meet set goals for performance • Set and revise case reserves in accordance with the reserving policy • Identify potentially suspicious claims and refer to SIU; identify opportunities for third-party subrogation • Be accountable for the security of the financial processing of claims, as well as security information contained in claims files • Work with, and provide claim-specific guidance to, independent field adjusters • Partner closely with internal teams and advise leadership of key claim activities and exposures