Senior Claim Quality Assurance Director

JOB DESCRIPTION

As a member of the Claims Quality Assurance Team, a person in this position is responsible for supporting continuous improvement by measuring aggregate reviews and claims handling performance.

Responsibilities also include partnering with various levels of internal and external claims management to analyze and communicate findings to underwriting regional management, claims management, and actuarial business partners.

This position reports to the AVP Quality Assurance manager.

Roles and Responsibilities:


* Assists in the selection of aggregate accounts on an annual basis and develops a workflow for completing necessary tasks within the allotted timeframe provided by underwriting.


* Performs a thorough analysis of reserve adequacy for specifically designated Chubb Global Casualty and Construction accounts, evaluates results and translates findings into key areas of focus for the account and/or Third-Party Administrator.


* Collaborates and functions as a liaison with various internal underwriting branch managers and underwriters.

This position will determine if there are any known issues with an account and use relevant information to determine the approach for a specific aggregate review.


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


* Leads aggregate 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.


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


* Interact with multiple business partners (Underwriting, Claims, Internal Audit, TPAs, and Accounts as required.


* Strong contributor to the team, shares ideas, corrective actions, or other QA collateral with the QA team and across claims units, inclusive of Quality Assurance Reviews for TPAs and internal reviews.


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

QUALIFICATIONS



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


* Multiple jurisdictional claims handling experience.


* At least 5 years of experience in Workers' Compensation.


* Insurance designation preferred.

Skills and Experience:


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


* Technical knowledge of the Workers Compensation line of business.


* 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....