CLAIMS QUALITY ASSURANCE MANAGER
Company: Quincy Mutual Group
Posted on: August 2, 2022
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.
- 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
- 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.
- 4-year college degree or equivalent experience.
- Associate in Claims (AIC) preferred.
- Possess or will obtain Adjusters licenses for CT and RI within
- Minimum of 5 years as a Claims Adjustor/Examiner across
- Experience in claims QA/Audit required
- Demonstrated competencies:
- Developing procedures
- Design and delivery of training
- Developing reports and metrics
- Personal and commercial auto claims experience in MA, CT and
- Property, Automobile Property Physical Damage, PIP and Injury
- Leadership and Technical expertise
- Superior verbal and written communication skills.
- Superior ability to present training in individual and group
- Superior organizational and desk management skills.
- Solid understanding of all relevant insurance concepts.
- Proficient with varying laws of comparative negligence and
- Ability to understand and analyze automobile policies and
- Solid understanding of insurance claims best practices,
procedures and industry trends.
- Proficient use of Microsoft Office (Excel, Word, Power
Point).On-site in office for training period and then hybrid
schedule once fully trained.
Keywords: Quincy Mutual Group, Quincy , CLAIMS QUALITY ASSURANCE MANAGER, Executive , Quincy, Massachusetts
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