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Claims Quality Assurance Manager

Location: Tampa, FL
Position Number: 00766
# of openings: 1

Description

POSITION SUMMARY:  This position is responsible for managing the Claims Quality Assurance program. Quality Assurance involves auditing claims to assure accurate coverage analysis, investigation, valuation, reserving, and disposition of claims.  This position supports the Claims Organization in achieving excellence in service quality and claim resolution, in accordance with State and company guidelines. The Quality Assurance Manager assists with the development of business processes and training for same in response to quality results.  The position mandates successful completion of all requirements of Fundamentals Claims School, which includes obtaining an overall passing score.

 

ESSENTIAL FUNCTIONS: THE FOLLOWING ARE THE USUAL, BASIC AND ESSENTIAL FUNCTIONS OF THE POSITION.  THESE FUNCTIONS ARE NOT TO BE CONSTRUED AS AN EXHAUSTIVE LIST OF ALL RESPONSIBILITIES, DUTIES, AND SKILLS REQUIRED.

  • Facilitate a work environment that fosters and supports ethical decision-making and actions by motivating, promoting and modeling ethical behavior, as well as executing job responsibilities in accordance with Citizens core values and ethics policies.
  • Manage activities and personnel of the Claims Quality Assurance department including training, development, mentoring, counseling, scheduling, and performance evaluations.
  • Work with and support the Claims Organization for quality assurance and training needs.
  • Communicate with internal and external Claims partners, Underwriting, and Human Resources. Administer the Claims Quality Assurance Programs including closed file audit program and field reinspection program.
  • Facilitate audit calibration meetings.
  • Develop action plans and assist with development of training for quality improvement strategies.
  • Oversee effective closed claim file audit review program, reinspection review program, and other quality assurance practices.
  • Assist in identifying, monitoring and analyzing quality measurements; conduct trending analysis; identify leakage; and prepare reports for Claims leadership.
  • Provide feedback based on claim quality review results and makes recommendations for improvements to Claims Management.
  • Conduct and/or participate in feedback sessions on an on-going basis with Claims management, staff, and external business partners.
  • Identify training opportunities based on claim quality review results.
  • Support the development and implementation of process-specific, competency-based Claims specific education programs.
  • Leverage technology and other resources to achieve greater efficiency and improved results in quality assurance programs.
  • Assist management in negotiating and executing contracts for quality assurance products and services as necessary.
  • Perform responsibilities and provide recommendations in accordance with latest trends and Citizens policies regarding claims issues.
  • Participate and contribute as an active member of the Claims Organization. 
  • Assess quality results for external business partners involved with handling Citizens’ claims.
  • Participate in Catastrophe planning and response, including Catastrophe Quality Assurance program.
  • Create and manage department budget.

 

Required KNOWLEDGE, SKILLS and ABILITIES:

  • Strong planning and organizational skills.
  • Strong leadership/managerial skills.
  • Strong verbal and written communication skills.
  • Comprehensive knowledge of property and casualty claims practices.
  • Strong analytical skills.
  • Ability to effectively manage departmental budget.
  • Computer proficiency in Microsoft Word, Excel, Power Point, and Outlook.
  • Ability to work in a highly energetic and flexible work environment.
  • Knowledge of Xactimate property estimating programs and Xactanalysis.

 

Required education and experience:

  • Bachelor’s degree in Business Administration or related field with skills transferable to insurance OR 4 years of relevant experience OR a combination of college education and relevant experience equivalent to 4years in college.
  • 5 or more years of Personal /Commercial Property and Casualty claims handling experience including field experience.
  • 2 or more years of quality assurance experience including field reinspection experience in property and casualty claims.
  • 2 or more years of supervisory/managerial experience to include Property and Casualty File Quality Assurance and Estimate Reinspection experience.
  • Active Florida Adjuster license (620 or 644) - Appointment Required.
  • The position mandates successful completion of all requirements of Fundamentals Claims School, which includes obtaining an overall passing score.

 

PREFERRED QUALIFICATIONS:

  • 8 or more years of Personal /Commercial Property and Casualty claims handling experience including field and quality assurance and/or reinspection experience.
  • 5 or more years of supervisory/managerial experience to include Property and Casualty File Quality Assurance and Estimate Reinspection experience.
  • Insurance designation (AIC, CPCU, etc.)

 

PHYSICAL REQUIREMENTS:

This position requires the ability to be physically mobile and operate a motor vehicle. Ability to sit, hear and converse over the telephone, and key frequently on a computer. Position may require up to 50% overnight travel including catastrophe response.
 





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