Claims QA Analyst

Description

Under direction of the Quality Control Management, the Quality Assurance Analyst, will serve as an integral role within the claim’s organization, helping to drive operational efficiencies and improve claim handling by providing insights regarding claim handling, compliance, and customer service. The Quality Assurance Analyst is responsible for working collaboratively with members of the claims department and management across the organization while continuously supporting the improvement of the technical quality of the claims product while measuring compliance through the completion of quality reviews. The Quality Assurance Analyst will partner with various levels of claims management to analyze and communicate findings, recommend solutions, and assist in the development of meaningful action plans.

Duties And Responsibilities

• Conduct quality audit file reviews.
• Assist in the sharing and distribution of best practices through written reports, PowerPoint presentations, oral presentations, and various reporting platforms.
• Assist in or facilitate the calibration process for claim managers and the audit team.
• Monitor, analyze and improve claims performance in all areas including loss control, LAE, customer satisfaction, associate engagement, and development.
• Assist in the development and implementation of any company customer satisfaction surveys or net promoter scores;
• Complies with state and federal laws, Department of Insurance criteria, insurance carrier criteria and follows and enforces Aspire General Insurance Company/partner’s policies, procedure and work rules;
• Performs a thorough analysis of quality review results and translates results into key opportunity areas.
• Assist in the development and maintenance of claim procedure manuals.
• Work with all levels of claims staff to ensure that the claims department is functioning at its best level of performance.
• Assist in the recognition of the need for technical improvements in any system used by the claims department and work with I/T in the development of those system enhancements.
• Assist in the development and enhancement of Aspires’ best practice guidelines.
• Perform ad hoc auditing depending on the needs of the company.
• Assist in testing processes, procedures, systems, and reports.
• Actively participate in training claim handlers on technical claims content and analysis of audit findings.
• A strong contributor to the team, sharing ideas, corrective actions, or other QA collateral with the AQ team and across the claim organization.
• Stay current on compliance laws and insurance regulations in multiple jurisdictions.
• Assist and actively participate in various projects within the claims organization, which includes but is not limited to file handling.
• Interact with multiple business partners as required.
• Ensure ongoing adjudication of claims within company standards and industry best practices and regulations.
• Support Aspires’ ongoing digital and process enhancements, providing innovative solutions for utilizing data management.
• Produce grammatically correct and clearly written correspondence including letters, memos, reports and claim file documentation.
  
  

Requirements

QUALIFICATIONS AND SKILLS:

• At least 2 years’ experience in Property and Casualty insurance industry (Non-Standard Preferred)
• Knowledge of Insurance industry and claims handling trends, compliance, and law
• Expertise in technical knowledge of Property and Casualty claim handling.
• Supervisor or management experience preferred.
• Thorough knowledge of Aspires’ best practice and claim processes.
• Excellent interpersonal, written, and verbal communication and problem resolution skills.
• Proficient information systems understanding and skills, to include Microsoft Office programs, and the internet.
• Ability to dissect QA data elements, identify root causes/trends, and quantify the “cost of non-compliance”.
• Ability to provide consultation and expert advice to management.
• Ability to excel independently and in a team environment.
• Must be a self-starter and have the ability to work independently.
• Must be able to effectively manage time, projects, and resources.
• Must have a clear understanding of insurance industry practices, standards, and terminology.
• Experience handling subrogation, property damage and injury claims required.
• Must be able to pass a background check.
• Must have the ability to work in a high volume, fast paced environment while managing multiple priorities.
• Must have a disciplined approach to all job-related activities.
• Must have a solid foundation of personal organization, sound decision making and analytical skills, strong interpersonal and customer service skills.
  
  

Inter-relationship Component

• Ability to develop excellent working relationships with Staff, Partners, Clients and outside agencies.
• Ability to communicate with others in an effective and friendly manner, one that is conducive to being a conscientious team member, fostering a spirit of goodwill, indicative of a professional environment and atmosphere.
• Ability to be a team player and work cohesively with other Aspire General Insurance and Partner Companies’ staff to achieve company goals.
• Able to represent the Company in a professional manner and contribute to the corporate image.
• Able to consistently provide excellent service.
  
  

Working Conditions

• This is a non- exempt position which complies with an alternative work schedule when applicable.
• This work environment is fast-paced, and accuracy is essential to successful task completion;
• The office is that of a highly technical company supporting a paperless environment.
• Travel may be required.
• Requires extended periods of computer use and sitting.

Aspire General Insurance Company