Senior Claims Quality Consultant responsible for quality reviews and audits for claims processes in a property and casualty insurance company. Ensuring compliance with regulatory standards and industry best practices.
Responsibilities
Responsible for quality reviews of claim files, aligning with the company’s regulatory and quality framework, promoting adherence to claims handling best practices
Conduct regular file reviews and audits to assess compliance with internal guidelines, industry standards, and regulatory requirements
Analyze and interpret key performance indicators and metrics to identify claims trends as well as opportunities for improvement
Evaluate claim outcomes against best practices and collaborate with the Claims Management to offer constructive, objective feedback, including suggestions for enhancements, training, and corrective measures
Partner with Claims leadership to support ongoing improvements and operational efficiency initiatives
Maintain, and report on quality metrics, scorecards, and dashboards to track performance
Confer reserve and settlement authority to claims staff within delegated authority
Stay up to date on multi-jurisdictional legal developments and industry trends to ensure compliance and informed decision-making
Provide reinsurance reports to ensure compliance with our reinsurance reporting guidelines
Requirements
Bachelor’s degree or equivalent work-related experience
5 years commercial lines claims
2 years quality assurance experience
Demonstrated in-depth knowledge of claims processes and procedures, including coverage analysis, investigation, evaluation, and settlement
Familiarity with regulatory requirements, litigation management, and industry best practices
Strong analytical and problem-solving skills with a detail-oriented mindset
Proficient computer skills required including Microsoft Office Suite
Excellent communication, interpersonal, and presentation skills
Excellent problem solving, critical thinking and decision making skills
Proficiency in claims management systems (e.g., Guidewire, ClaimCenter) and quality/audit tools
Ability to handle confidential and sensitive information
Experience with quality frameworks (e.g., Six Sigma, ISO 9001)
Experience in a multi-jurisdictional claims environment
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