Claim Quality Assurance Director

JOB DESCRIPTION

As a member of the Claims Quality Assurance and Compliance Team, a person in this position is responsible for supporting continuous improvement by measuring compliance in quality audits.

Responsibilities also include partnering with various levels of internal and external claims management to analyze and communicate findings, recommending solutions and working collaboratively in the development of meaningful action plans.

This position reports to a Quality Assurance and Compliance Team manager.

Roles and Responsibilities:


* Conducts Claim Technical Quality Audits of:
+ CHUBB Claims Practice Disciplines/Segments/Offices
+ Third Party Administrators
+ Self-Administered Programs


* Assists in the sharing and distribution of Best Practice review results through written reports and presentations.


* Facilitates the calibration process for claim managers that perform Self Reviews.


* Performs a thorough analysis of quality review results and translates results into key opportunity areas.


* Collaborates with claim management in the development of meaningful action plans that detail the tasks, resources, and timeframes necessary to improve claim handling.


* Facilitates, supports, and measures the execution of action plans.


* Assists in the development and enhancement of CHUBB's Best Practice Guidelines.


* Leads quality reviews including pre-work such as file selection and communication, assuring the review process is proper and timely, and reporting at the conclusion of the review.


* Leads or actively participates in training claim handlers on technical claims content.


* Provides training to managers in the use of the quality review tool for results and analysis.


* Interact with multiple business partners (Underwriting, Claims, Internal Audit, TPAs, Accounts, Office of General Counsel etc.) as required.


* Strong contributor to the team, shares ideas, corrective actions, or other QA collateral with the QA team and across claims units.


* Stays current within respective field(s) of expertise, jurisdictional changes and relative licensing.


* Up to 20% travel.

Skills and Experience:


* Knowledge of Insurance Industry and Claims Handling (TPA and Carrier perspective)


* WC: Deep technical knowledge of the Workers Compensation line of business.

Experience in Accident & Health and Personal Injury Protection/Medical Payment claims is preferred.


* Thorough knowledge of CHUBB products, services, and coverages along with a good understanding of applicable legal principles.


* Excellent interpersonal, written and verbal communication and problem resolution skills


* Proficient information systems understanding and skills, to include Microsoft Office programs (Word, Excel, Access, and Power Point) and the internet.


* Ability to collect, dissect, and analyze complex data sets to identify root causes/trends, and quantify the "c...