Quality Control Manager P & C Claims (TPA)
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Job Location:
Rutherford, NJ - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
We are seeking an experienced Quality Control Manager to join our team. This role will be responsible for developing implementing and maintaining quality assurance programs for Property & Casualty claims operations within a Third-Party Administrator (TPA). This role drives accuracy consistency compliance with regulatory and internal standards and continuous process improvement across claims workflows.
This position will be located at our Rutherford New Jersey home office. Consideration will be made for Remote based candidates.
Key Responsibilities
Quality Assurance and Audit
Continuous Improvement
Leadership and Interaction
Metrics & KPI Accountability
Regulatory & Compliance Requirements
Qualifications
Raphael & Associates is a third-party claims administrator and independent claims adjusting company internationally recognized for exceptional service. We understand the importance of adapting to the demands of a dynamic market and we tailor our services to our clients specific needs. As a claims organization what we do is complex. Our mission is simple: to provide outstanding service retain extraordinary professionals and utilize the best technology in the industry!
As a leading organization in the industry we offer dynamic and challenging opportunities to individuals who want to make a difference. We value camaraderie vision a passion for excellence creativity and self-reliant professionals.
Benefits and Perks
We are an organization that recognizes and appreciates hard work! We offer a competitive compensation package commensurate with experience including salary bonus paid time off medical/dental/vision/life insurance and 401k (with matching!). Most importantly you will have the opportunity to work directly alongside an extraordinary and dedicated team to grow a critical function within a dynamic growing company.
This position will be located at our Rutherford New Jersey home office. Consideration will be made for Remote based candidates.
Key Responsibilities
Quality Assurance and Audit
- Design and implement quality measurement tools scorecards checklists and sampling methodologies.
- Define maintain and evolve quality assurance standards for P&C claims.
- Conduct regular quality audits sampling claims across adjusters teams and lines of business.
- Ensure consistent application of standards policies and procedures across claims operations.
- Document and report findings. Provide actionable recommendations and monitor corrective action plan.
Continuous Improvement
- Lead initiatives to improve claims accuracy cycle times compliance and customer outcomes.
- Partner with operations leadership to identify training needs based on quality trends.
- Facilitate or deliver quality-focused training sessions for claims adjusters and supervisors.
- Drive projects to implement best practices process enhancements and automated quality controls.
Leadership and Interaction
- Serve as a subject matter expert and trusted advisor to Claims Operations Leadership.
- Work cross-functionally with training compliance operations IT and risk management teams.
- Coach and mentor quality analysts and support staff.
- Provide regular briefings to senior leadership on quality results risks and improvement plans.
Metrics & KPI Accountability
- Establish and track quality KPIs such as:
- Claims accuracy rate.
- Documentation completeness/consistency.
- Severity subrogation and reserve accuracy.
- Cycle time variances.
- Error rates by adjuster/team.
- Lead root cause analysis and track corrective action effectiveness.
Regulatory & Compliance Requirements
- Ensure QA programs comply with state insurance regulations industry standards and contractual obligations.
- Maintain familiarity with NAIC guidelines state-specific claims handling regulations (e.g. unfair claim settlement practices) and audit requirements.
- Support internal and external regulatory exams and audits as needed.
Qualifications
- Bachelors degree in Business Insurance Risk Management or a related field required; Masters degree preferred.
- Preferred Certifications:
- CPCU AIC ARM CAMS or Six Sigma/Lean Certification.
- 5 years of experience in P&C claims operations within a TPA insurance carrier or equivalent environment.
- 3 years of experience in quality quality control or audit functions specifically supporting P&C claims.
- Strong understanding of P&C policy coverages claims lifecycle adjudication standards and claims documentation best practices.
- Experience with industry quality standards and tools.
- Prior experience in outsourced TPA quality frameworks vs. captive carrier environments is a plus.
- Excellent written and verbal communication.
- Comfortable presenting to executive leadership and engaging at all organizational levels.
- Strong organization prioritization and project management skills.
Raphael & Associates is a third-party claims administrator and independent claims adjusting company internationally recognized for exceptional service. We understand the importance of adapting to the demands of a dynamic market and we tailor our services to our clients specific needs. As a claims organization what we do is complex. Our mission is simple: to provide outstanding service retain extraordinary professionals and utilize the best technology in the industry!
As a leading organization in the industry we offer dynamic and challenging opportunities to individuals who want to make a difference. We value camaraderie vision a passion for excellence creativity and self-reliant professionals.
Benefits and Perks
We are an organization that recognizes and appreciates hard work! We offer a competitive compensation package commensurate with experience including salary bonus paid time off medical/dental/vision/life insurance and 401k (with matching!). Most importantly you will have the opportunity to work directly alongside an extraordinary and dedicated team to grow a critical function within a dynamic growing company.
Required Experience:
Manager
Key Skills
- Laboratory Experience
- Quality Assurance
- Construction Experience
- FDA Regulations
- ISO 9001
- Assays
- Quality Systems
- Quality Control
- Quality Management
- cGMP
- QA/QC
- HACCP
About Company
EXPERIENCE AND INTEGRITY: RAPHAEL STANDARDSRaphael & Associates is a Third Party Administrator and Independent Claims Adjusting company internationally recognized for its exceptional service and unsurpassed reputation of nationwide claims handling.Third
