Claim Quality Assurance Director
Claim Quality Assurance Director
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Salary Not Disclosed
1 Vacancy
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 also include partneringwith various levels of internal and external claims management to analyze and communicate findings recommending solutions and working collaboratively in the development of meaningful action 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 CHUBBs 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 cost of non-compliance.
- Ability to provide consultation and expert advice to management.
- Ability to excel independently and in a team environment.
- Excellent time management and organizational skills.
- Strong background in Insurance Operations preferred.
Qualifications
- Bachelors degree in related field or proven insurance related experience.
- Multiple jurisdictional claims handling experience.
- At least 7years of experience in Workers Compensation. Multi-line experience is preferred particularly within Personal Injury Protection/No Fault and Accident & Health.
- Claims supervisory or management experience is preferred.
- Insurance designation preferred.
Required Experience:
Director
Employment Type
Full-Time
