Analyst, Insurance Claims Quality Assurance
5 months ago
Job ID : 7061
Category : Claims
Brand : Definity
Regular/Temporary : Regular
Fulltime/Parttime : Full Time
Location : Ottawa, Canada
Definity includes some of Canada’s most long-standing and innovative insurance brands, including Economical Insurance, Sonnet Insurance, Family Insurance Solutions, and Petline Insurance. With strong roots that date back to 1871, we’ve grown to become a digital leader in the insurance industry. We’re proud to help our clients and communities adapt and thrive in a world of constant change.
Our promise to you: It’s better here. Why? Because we CARE, and we provide an employee experience that’s collaborative, ambitious, rewarding, and empowering.
Our ambition is to be one of Canada’s leading and most innovative P&C insurers. Come be a part of our journey, and love what you do.
Definity offers a flexible, hybrid work experience where employees work from the office and virtually depending on the type of work they are doing and who they are working with. Leaders partner with their teams to find the right balance of on-site and remote work that best meets the needs of their teams, colleagues, brokers and customers, while ensuring collaboration, teamwork and accountability for goals.
The Analyst, National Claims Quality Assurance, will lead the implementation and execution of a technical file review program within the claims area of the business including coverage of multiple regions/jurisdictions. This Line 1B defense mechanism for Claims ensures our claims file handlers and leaders are:
- Meeting customer expectations
- Ensuring case reserves are timely and accurate
- Managing claims according to regulatory requirements
- Adhering to other file handling practices to Economical standards
**What can you expect in this role?**
- Work with Claims VPs and Directors, Actuarial and Insurance Risk teams - within claims operations to drive claims handling insights and impact while supporting Claims in their action planning and resolution
- Report the results of these reviews into 2 new sub-committees (Claims Risk & Control and Reserving committee/sub-committee) to promote a strong risk and control environment
- 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 such as: testing scripts and interpretation notes, working papers, etc.
- Complete file reviews
- Make recommendations on findings, agreeing with key claims stakeholders to appropriately manage risks
- Report findings to Risk & Reserving committees, senior leaders and other key stakeholders as required
- Manage internal and external resources supporting this work
- Recommend and influence any necessary changes to company policies, guidelines and best practices
- Ensure all reviewers (Claims Leaders, Claims Technical Advisors, Claims Quality Assurance) are calibrated for a consistent approach in auditing claims files
- Obtain agreement with Claims Leaders and Claims Technical Advisors on establishing best-in-class standards for audit and minimum thresholds for lines of business and file handling performance, including developing leakage methodology
- Incorporate data analytics to measure and monitor adherence to regulatory and company standards, including idea generation, designing automated testing procedures and investigating potential gaps and incorporating findings into the reporting process
- Provide advisory and consultative services on claims file management, claims process effectiveness, risk management and control on new initiatives, process changes, existing processes and from ad hoc requests
- Problem solving from root cause analysis on issues to developing and implementing solutions
- Work with Claims, Actuarial, Risk, IT, Legal & Compliance, Finance and Underwriting
- 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, including assisting with new regulatory requirements, process and controls mapping/documentation, framework updates and/or development
- Monitor emerging best practices in risk management, audit and control to improve the organization's ability to identify, assess, mitigate, govern and report
- Develop techniques to make control testing more efficient and effective
**What do you bring to the role?**
- Strong 5+ years claims career including; 5+ years of Sr. Adjuster and/or Specialist experience in direct claims handling of at least one major line of long tail claims business (Bodily Injury/Casualty or Accident Benefits)
- Multi-line claims handling experience is an asset but not necessary
- Experience in audit, risk management, regulatory compliance, processes and controls is preferred but not necessary
- Experience as a claims leader is an asset b
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