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Bilingual Quality Assurance Specialist
2 months ago
The Specialist, 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 1 defense mechanism for Claims ensures our claims file handlers and leaders are:
- Managing claims according to regulatory requirements
- Working with Claims VPs and Directors, Actuarial and Insurance Risk teams within the Quebec region to drive claims handling insights and impact while supporting Claims in their action planning and resolution
- Reporting findings and results (Claims Risk & Control and Reserving committee/sub-committee) to promote a strong risk and control environment, Risk & Reserving committees, senior leaders and other key stakeholders as required
- Supporting the development of claims technical file review audit methodology framework and processes
- Supporting the development of audit quality standards for each step of the audit process, such as testing scripts and interpretation notes, working papers, etc.
Make recommendations on findings, agreeing with key claims stakeholders to appropriately manage risk. 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.
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.
Strong 10+ years claims career including:
- 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
- Experience as a claims leader is an asset but not necessary
- Strong understanding of business operations and related legislative, regulatory and internal policy and procedure requirements
- Ability to build strong relationships externally and internally at all levels to help foster a positive compliance culture
- Proficient in Excel, Powerpoint and Word
- Bilingualism is mandatory (French/English)