Claims Quality Assurance Specialist

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠.

This position is responsible for serving as a Subject Matter expert for multiple claim lines of business and supporting Quality Assurance for Claims Adjusting teams. The lines of business involved are General Liability and Auto.   This role entails auditing the claims processes including coverage analysis, investigation, valuation, reserving, and accurate disposition of claims per Arch claims handling guidelines and best practices. This position is also responsible for assisting in business process improvement and preparing proactive claims solutions that maximize efficiencies and quality service to all internal and external customers.

Responsibilities:

• Establishment and Maintenance of the Claims Quality Assurance Review process for the Auto and General Liability lines of business within the Region.  
• Ensure claim handling consistency and discipline through management of the claims file review process in accordance with corporate and local claims guidelines. Conducting consistent individual claim file reviews and audits.
• Review audit reporting results for claims activity and create analytics to identify any trends and provide recommendations for improvements when determined.
• Create, present and perform calibration Quality Control training sessions and assist Claims employees to increase knowledge and skills necessary to achieve improved results.    
• Collaborate with Claim management, claims legal and claims product teams to develop strategies and business plans to reduce claims costs/expenses. 
• Assist with driving the achievement of financial targets (e.g. full combined ratio) and contribute to annual target setting for Claims.  
• Responsible for providing Claims Leadership with regular updates regarding Quality Assurance metrics and trends.
• Identifying the opportunities and needs of the Claims Adjusting teams and aid in providing resolution to issues at all levels.
• Act as a point of Quality Assurance related contact for internal escalated communications, and provide quick and effective resolution to escalated issues

• Seek guidance from Regional Head of Claims on issues that impact the Region and the Company.
• Identify or participate with new technology and other resources, to achieve greater efficiency and improved results.
• Assist the Claims Management Teams to assess the need for, and create specific Quality Control training for staff, adjusters and vendors within the claims department.

Knowledge and Skills:

• Exceptional interpersonal communication skills
• Previous claims handling experience
• Advanced analytical and coaching skills 
• Detail oriented.
• Ability to balance multiple responsibilities over multiple claims departments and gather relevant data from both management and adjusters to address and resolve complaint issues.
• Knowledge of Quality Assurance Audit processes and training principles.
• Strong strategic planning and stakeholder management skills

Experience and Education:

• Some college preferred.
• Minimum of 5 years of insurance claims adjusting experience; across multiple lines.
• Experience with file audits in multiple Lines of Business

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