Claims QA Manager

POSITION SUMMARY:

The Claims QA Manager is responsible for the Quality Assurance Review, Internal audit, and Training for the Claims team. This position will establish Quality Assurance procedures and perform reviews for Claims handling, from First Notice of Loss through Closing and Subrogation, to ensure timely, efficient, fair, and prudent processes consistent with the Company’s established ‘Claims Philosophy’ and ‘Standard Operating Procedures.’

This position will work with claims management to maintain Standard Operating Procedures and a training curriculum in compliance with laws and regulations. Supports a positive learning environment by developing, organizing and presenting individual and group training sessions pertinent to quality claim resolution for Claims leaders and adjusters/examiners as needed.

Conducts file reviews to ensure adjusters/examiners understand and apply training subject matter on a consistent basis.

This position also develops reporting on trend analysis, establishes measurable Key Performance Indicators for quality assurance and training to support continuous quality improvement within the Claims Department.

Over time, role may broaden with additional responsibilities pertaining to quality and training to meet the needs of other Claims functions.

PRINCIPAL ACCOUNTABILITIES:

Quality Assurance and Compliance
*Design and implement Quality Assurance standards and processes focused on quality claim resolution complying with internal standards, contract obligations and regulatory requirements
*Create and present calibration quality control sessions to assist claims employees in increasing knowledge and skills necessary to achieve improved results.
*Conduct Claims audits, providing feedback to claims adjusters/examiners and management in a timely and effective manner.
Training
*Assure Claims staff gains thorough knowledge and understanding of claims procedures, concepts, and laws through application of effective training methods.
*Prepare and deliver effective individual and group training presentations based on the needs of the Claims department.
*Research and organize relevant external training seminars and webinars to supplement in-house training programs.
*Assist onboarding and mentoring of new staff and internal transfer / promotions, collaborating with claims leadership, IT, HR and other business partners.
*Work closely with all levels of management to identify training needs not covered by existing modules and seminars.
Reporting, Analytics, and Continuous Improvement
*Stay abreast of current industry trends, case law and other current developments that could affect claim handling.
*Identify new technology and other resources to achieve greater efficiencies and improve results.
*Develop reports to monitor Claims quality (timely, efficient settlement of Claims at fair terms), trends and identify opportunities to improve quality performance and training.