Senior Claims Quality Assurance Analyst

October 15

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Aspire General Insurance

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201 - 500

Description

• Conduct quality audit file reviews. • Participate in or lead various claim projects or targeted audits. • Assist in the sharing and distribution of best practices through written reports, PowerPoint presentations, oral presentations, and various reporting platforms. • Lead 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. • Actively participate 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, and insurance carrier criteria and follows and enforces Aspire General Insurance Company/partner’s policies, procedures, 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 and training manuals. • Work with all levels of claims staff to ensure that the claims department is functioning at its best level of performance. • Identify 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. • Actively participate in enhancements and serve as an agent of change 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. • 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

• Four plus years experience in the 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 practices and claim processes. • Excellent interpersonal, written, and verbal communication and problem-resolution skills. • Proficient information systems understanding and skills, including 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 is 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, and strong interpersonal and customer service skills.