Senior Claim Quality Assurance Director

JOB DESCRIPTION

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 adherence to claims handling expectation in quality reviews.

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

This position reports to a Quality Assurance Manager, AVP.

Responsibilities:


* Conduct Claim technical quality reviews for both direct handled and third party administered Casualty claims.


* Assist in the sharing and distribution of review results through written reports and presentations.


* Facilitate the calibration process for claim managers that perform manager reviews.


* Perform a thorough analysis of quality review results and translate results into key opportunity areas.


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


* Facilitate, support, and measure the execution of action plans.


* Lead 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.


* Lead or actively participate in training claim handlers on technical claims content.


* Provide 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, Global Legal & Compliance), as required.


* Contribute to the team, share ideas, create corrective actions, and identify root causes across claims units.


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


* Up to 10% travel.

QUALIFICATIONS

Qualifications:


* At least 10 years of experience in Casualty claims is preferred.


* Bachelor's degree in related field or proven insurance related experience.


* Multi-jurisdictional claims handling experience.


* Claims supervisory or management experience is preferred.


* Bachelor's degree or insurance designation preferred.


* Claim adjuster licensing desired.

Skills and Experience:



* Deep technical knowledge of the Casualty line of business with 10 years of experience.


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


* 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, leakage and quantify ...