Conduct claim file quality and leakage reviews. Review all aspects of claims files specific to assigned product area (e.g., workers' compensation, casualty, automobile and property) to determine the compliance with claims handling standards and procedures. Recommend steps to improve the performance of the quality assurance program as well as for education, training, and mentoring programs of claim professionals. Coordinate with claim management to prepare action plans and address technical development needs. Participate in the preparation and delivery of the audit program findings to management. Participate in the calibration process of the supervisory/management team. In collaboration with Corporate Training will develop and assist in delivering claims training. Assist in business process improvement and preparing proactive claims solutions that maximize efficiencies.
DUTIES AND RESPONSIBILITIES:
- Conduct claim file quality and leakage reviews and other quality assurance projects as needed.
- Determine, monitor, and analyze measurements; conduct trending analysis; identify leakage; and prepare objective reports for management.
- Assist in the development and implementation of quality improvement strategies for the quality assurance program.
- Create, present, and perform calibration quality assurance training sessions and assist claim supervisor/managers to increase knowledge and skills necessary to achieve improved results.
- Assist the department to assess the need for and create specific quality assurance training for staff, independent adjusters, and vendors.
- Contribute to the development of process-specific, competency-based education programs as necessary in conjunction with the corporate training team that will include train the trainer and end-user programs.
- Create, maintain, and update quality assurance training materials as necessary for use in quality assurance training sessions.
- Assist in the development and implementation of claims strategies, best practices, handling processes, programs, and controls leading to increased productivity and quantifiable loss cost and expense savings.
Required Skills
- Experience and/or demonstrated interest in business strategy, quality management, process improvement, and analytics related to property and casualty claims.
- Deep technical expertise in casualty, workers' compensation, subrogation, litigation, claims reinsurance, claims quality improvement, claims systems development, and/or operational management.
- Experience completing quality and leakage reviews.
- Knowledge of quality assurance and training principles.
- Excellent analysis, communication, presentation, and project management skills.
- Work collaboratively to effectively implement claims quality and/or transformational strategies.
- Proven track record in supporting the development and implementation of claims strategies, best practices, handling processes, programs, and controls leading to increased productivity and quantifiable loss cost and expense savings.
- Ability to work in a team environment and demonstrate a keen attention to detail.
- Ability to support creation and presentation of high-quality work products suitable for senior executives.
- Strong internal customer focus with ability to develop and manage relationships with claims personnel and claims project team members.
- Strong interpersonal skills--team leadership, relationship building, and communication.
- Strong performance management, financial awareness, and colleague development skills.
- Demonstrate personal qualities of sound planning, deep claims domain expertise, problem dissection and resolution, commitment to excellence, and decisiveness.
- Broad business acumen.
- Fluency in Microsoft Office applications--Excel, PowerPoint, Microsoft Word, etc.
- Ability to translate technical data into user-friendly documentation, training materials, process flows, etc.
- Ability to effectively lead teaching/training sessions.
Required Experience
- Minimum five years' experience in property and casualty claims handling and/or frontline operational management and/or claims quality management.
- Experience in originating or participating in successful claims transformation projects or initiatives is preferred.
EDUCATION:
- A four-year degree or equivalent experience is required.
- Holding or working toward a professional designation, such as CPCU, AIC, or other approved designation, is preferred.