About the role

  • 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
  • Ability to travel up to 10%

Benefits

  • competitive base pay
  • performance-based incentive pay
  • comprehensive health and welfare benefits
  • 401(k) savings plan with profit sharing
  • generous paid time off programs
  • flexible work arrangements

Job title

Senior Claims Quality Consultant

Job type

Experience level

Senior

Salary

Not specified

Degree requirement

Bachelor's Degree

Tech skills

Location requirements

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