Business Analytics Consultant Senior utilizing AI and analytics for solutions in PNC's Retail Bank Operations. Delivering data insights and driving decision - making through complex analytical tools and methodologies.
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
Job type
Experience level
Salary
Not specified
Degree requirement
Tech skills
Location requirements
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