Claims Quality Assurance Analyst

Description

Position Summary:

The Quality Assurance (QA) Analyst is responsible for performing completing tasks in support of FPM CQA objectives. This positions primarily function is to conduct systematic quality file reviews of first-party property / third-party casualty claims from internal and external claim operations, in accordance with FPM handling guidelines and best practices. The QA Analyst also evaluates error trending from audits and recommends areas for Litigation and Claims Department training. Assists with training efforts as requested.

Essential Functions:

• Completes open, closed, and double litigation claim file reviews in compliance with established CQA processes and procedures
• Participates in root cause analysis (5 why's, Kepner-Trego, Fishbone, etc.)
• Complete ad hoc file reviews to determine extent of issues identified as requested
• Participates in process improvement efforts to assist with efficiency, development, and implementation of new litigation/claims processes and procedures to ensure compliance with CQA standards
• Performs process and procedure training - serves as subject matter expert resource in support of training efforts as requested
• Participates in roundtable weekly discussions as a claims and field adjusting subject matter expert; identify areas for improvement/training opportunities
• Complete post-review follow-up items as requested
• Reviews claims and field adjusting departmental materials prior to rollout as requested
• Other duties as assigned, with or without accommodation
• Present a professional, transparent, and helpful philosophy
• Assist in other department areas as requested

Qualifications

Required Education and Experience:

• Bachelor's degree from a regionally accredited university or equivalent insurance background and education
• Strong comprehensive subject matter expert knowledge of property/casualty claims handling practices, cause of loss investigation analysis, damage assessment, estimating software platforms, Florida State Statute and Administrative Code.
• 5+ years property/liability complex coverage claims and field adjusting (carrier-level) experience specific to lines of business written by Florida Peninsula Managers
• PC literate with a firm understanding of Microsoft Office Programs
• Ability to communicate effectively both orally and in writing
• Strong analytical and negotiating skills

Competencies:

• Integrity and Trust
• Functional/Technical Skills
• Decision Quality
• Approachability
• Informing
• Patience
• Interpersonal Savvy
• Intellectual Powerhouse

Preferred qualifications:

• Quality Assurance file review experience
• Training / Mentorship of Others on overall claims handling and field adjusting experience