Claims Quality Specialist, Governance
7 days ago
Join our team at Definity, a leading property and casualty insurer in Canada, as a Specialist, National Claims Quality Assurance. In this role, you will lead the implementation and execution of a technical file review program within the claims area of the business, ensuring our claims file handlers and leaders meet customer expectations, manage claims according to regulatory requirements, and adhere to Definity standards.
Key Responsibilities:- Work with Claims VPs and Directors, Actuarial and Insurance Risk teams to drive claims handling insights and impact while supporting Claims in their action planning and resolution
- Report findings and results to promote a strong risk and control environment, and communicate with senior leaders and other key stakeholders as required
- Support the development of claims technical file review audit methodology framework and processes
- Provide input/insight in developing the annual audit plan
- Support the development of audit quality standards for each step of the audit process
- Complete file reviews and make recommendations on findings, agreeing with key claims stakeholders to appropriately manage risk
- Manage internal and external resources supporting this work
- Recommend and influence any necessary changes to company policies, guidelines, and best practices
- Ensure all reviewers are calibrated for a consistent approach in auditing claims files
- Incorporate data analytics to measure and monitor adherence to regulatory and company standards
- Provide advisory and consultative services on claims file management, claims process effectiveness, risk management, and control
- Problem solving from root cause analysis on issues to developing and implementing solutions
- Work with Claims, Actuarial, Risk, IT, Legal & Compliance, Finance, and Underwriting teams
- Foster awareness of the company's policies and procedures through regular communication, training, and employee engagement
- Help to implement any new requirements, controls, close action items as needed
- Strong 10+ years claims career, including 5+ years as Sr. Adjuster and/or Specialist
- Experience in minimum 2 lines of claims business (Auto, Property, Bodily Injury/Casualty)
- Experience in audit, risk management, regulatory compliance, processes, and controls is preferred but not necessary
- Strong stakeholder management skills
- Strong understanding of business operations and related legislative, regulatory, and internal policy and procedure requirements
- Excellent analytical, written, and verbal communication skills
- Ability to build strong relationships externally and internally at all levels
- Proficient in Excel, PowerPoint, and Word
- Strong organizational and problem-solving skills
- Strong level of personal integrity
- Highly positive attitude and open-minded
- Thrives in a team environment and ability to also work independently
- Bilingualism is mandatory (French/English)
- Hybrid work schedule for most roles
- Company share ownership program
- Pension and savings programs, with company-matched RRSP contributions
- Paid volunteer days and company matching on charitable donations
- Educational resources, tuition assistance, and paid time off to study for exams
- Focus on inclusion with employee groups, support for gender affirmation surgery, access to BIPOC counsellors, access to programs for working parents
- Wellness and recognition programs
- Discounts on products and services
At Definity, we value diversity and inclusion, and we are committed to creating a workplace that is welcoming and supportive of all employees. If you are a motivated and experienced professional looking for a new challenge, we encourage you to apply.
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