Manager, Claims Quality Assurance

Job Summary

The Manager, Claims QA is a self-starter who is passionate about driving excellence and continuous improvement. The Claims QA Manager is responsible for assuring the Claims Department is adhering to established best practices by evaluating claim handling performance and creating impactful training that drives professional growth and exceptional service. The Claims QA Manager will build and manage a team of quality assurance professionals providing guidance coaching and oversight to enhance work product.  This position collaborates closely with Claim Leadership to achieve excellence in service quality, improve claim outcomes and foster continuous improvement.

Duties and Responsibilities

• Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
• Responsible for leading the quality and learning and development functions within the Claims department
• Analyze and audit claims to ensure accurate coverage analysis, investigation, valuation, reserving, and disposition of claims
• Work with Claims Leadership to refine, update and maintain Claims best practice guidelines
• Partner with internal stakeholders to ensure the efficacy of the Claims audit program
• Manage the Claims quality assurance program
• Monitor Claim Professional training to maintain licensing
• Develop and deliver Claims learning and development programs to improve job performance effectively and efficiently within the Claims department
• Ensure learning and development programs support overall cadence and tenor of enterprise training and development programs by partnering with the Human Resources department
• Analyze data on the effectiveness of Claims training programs and reporting the ROI of training and development initiatives
• Develop and maintain library of training materials and tools
• Ensure that project and department milestones and goals are met
• Interview, select and train new employees
• Guide and help team members with project issues
• Responsible for continued development of Claims best practices and procedures
• Track employee performance and provide regular and appropriate feedback
• Provide employee feedback through regular check-ins and writing and delivering performance reviews
• Lead team through obstacles and time constraints to overcome barriers and successfully deliver results

Knowledge, Skills and Abilities

• Advanced knowledge of claims handling principles and best practices
• Advanced knowledge of multiple P&C lines of business
• Advanced knowledge and experience managing claims and litigation process
• Ability to work on assignments that require a high technical level of expertise due to complexity and exposure, under minimal supervision
• Ability to stay current on emerging trends in learning design and development
• Ability to convey both technical and conceptual material in a clear and concise manner
• Excellent written and verbal communication skills
• Ability to develop an operation plan that aligns with and supports the overall business goals
• Ability to provide insights and recommendations from quantitative and qualitative data
• Ability to identify and make process and procedure improvement recommendations
• Ability to demonstrate business acumen and forward thinking-skills
• Ability to lead, motivate, influence, and mentor staff
• Ability to set clear expectations, effectively monitor progress, provide constructive feedback and guidance, and hold staff accountable
• Excellent organizational skills
• Ability to effectively communicate with all levels of the organization
• Advanced proficiency in MS Office (Word, Excel, Outlook)
• Ability to travel occasionally

Experience and Education

• Bachelor’s Degree in related field required
• Minimum seven years’ insurance claims/financial services/customer service industry experience required
• Three years’ experience with program instructional design, development and delivery, adult learning, continuing education preferred
• Three years’ experience with insurance/financial service/customer service quality assurance preferred
• Minimum of two years of people management experience preferred