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Claims Quality Assurance Specialist

3 months ago

Calgary, Alberta, Canada Definity Full time
Job Overview

The National Claims Quality Assurance Specialist will spearhead the development and execution of a technical file review initiative within the claims division of the organization, encompassing multiple regions and jurisdictions. This proactive defense mechanism for Claims guarantees that our claims file handlers and leaders are:

  • Meeting client expectations
  • Ensuring case reserves are timely and precise
  • Managing claims in accordance with regulatory standards
  • Adhering to other file handling practices that align with Economical standards

Key Responsibilities:

  • Collaborate with Claims VPs and Directors, Actuarial and Insurance Risk teams within Auto claims operations to enhance claims handling insights and support Claims in their action planning and resolution efforts
  • Present the outcomes of these reviews to two new sub-committees (Claims Risk & Control and Reserving committee/sub-committee) to foster a robust risk and control environment
  • Assist in the formulation of claims technical file review audit methodology framework and processes
  • Contribute insights in the creation of the annual audit plan
  • Aid in establishing audit quality standards for each phase of the audit process, including testing scripts and interpretation notes, working papers, etc.
  • Conduct file reviews
  • Provide recommendations based on findings, collaborating with key claims stakeholders to effectively manage risks
  • Communicate findings to Risk & Reserving committees, senior leaders, and other essential stakeholders as necessary
  • Oversee internal and external resources that support this work
  • Suggest and influence necessary modifications to company policies, guidelines, and best practices
  • Ensure all reviewers (Claims Leaders, Claims Technical Advisors, Claims Quality Assurance) are aligned for a consistent approach in auditing claims files
  • Reach consensus 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
  • Utilize data analytics to assess and monitor compliance with regulatory and company standards, including idea generation, designing automated testing procedures, and investigating potential gaps while integrating findings into the reporting process
  • Provide advisory and consultative services on claims file management, claims process efficiency, risk management, and control on new initiatives, process changes, existing processes, and ad hoc requests
  • Engage in problem-solving from root cause analysis on issues to developing and implementing solutions
  • Collaborate with Claims, Actuarial, Risk, IT, Legal & Compliance, Finance, and Underwriting
  • Promote awareness of the company's policies and procedures through regular communication, training, and employee engagement
  • Assist in implementing any new requirements, controls, and closing action items as needed, including supporting new regulatory requirements, process and controls mapping/documentation, framework updates, and/or development
  • Monitor emerging best practices in risk management, audit, and control to enhance the organization's ability to identify, assess, mitigate, govern, and report
  • Develop techniques to improve the efficiency and effectiveness of control testing

Qualifications:

  • A solid background with 5+ years in claims, including 5+ years of Auto Adjusting and/or Auto Claims Appraisal experience
  • Multi-line claims handling experience is advantageous but not mandatory
  • Experience in audit, risk management, regulatory compliance, processes, and controls is preferred but not essential
  • Experience as a claims leader is beneficial but not required
  • Strong stakeholder management capabilities
  • Comprehensive understanding of business operations and related legislative, regulatory, and internal policy and procedure requirements
  • Exceptional analytical, written, and verbal communication skills
  • Ability to cultivate strong relationships both externally and internally at all levels to foster a positive compliance culture
  • Proficient in Excel, PowerPoint, and Word
  • Strong organizational and problem-solving skills with the capacity to gather information, analyze critically, and navigate complexities to develop workable solutions
  • High level of personal integrity
  • Positive attitude and open-mindedness
  • Thrives in a collaborative environment while also being able to work independently
  • Bilingualism is a plus

Compensation: Salary range $55,800 - $102,800

About Definity

Interested in this role, but don't meet every requirement? We encourage you to apply. We understand that a candidate doesn't need to meet 100% of the qualifications listed to bring significant value to our team. We are actively seeking diverse backgrounds and perspectives to enhance our mission of improving insurance. At Definity, inclusion, diversity, and equity are not just desirable — they are essential to our success.

Benefits:

  • Flexible 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 for exam preparation
  • Focus on inclusion with employee groups, support for gender affirmation surgery, access to BIPOC counselors, and programs for working parents
  • Wellness and recognition programs
  • Discounts on products and services

Actual salary for the role may vary depending on the work location of the successful candidate and other factors including but not limited to skills, education, experience, working conditions, and the local labor market. In addition to base pay, eligible employees may participate in various incentive plans, which are paid out at the discretion of the company and subject to individual and company performance.

Expect a lot — you deserve it.

Our inclusive work environment welcomes diversity and supports accessibility. If you require accommodation at any time during the recruitment process, please inform us.

Background Checks:

This role requires successful clearance of background checks (including criminal checks and leadership references).