Claims Quality Specialist, Governance
1 month ago
The Claims Quality Specialist, Governance will lead the implementation and execution of a technical file review program within the claims area of the business, covering multiple regions and jurisdictions. This role ensures our claims file handlers and leaders meet customer expectations, ensure timely and accurate case reserves, manage claims according to regulatory requirements, and adhere to Definity standards.
Key Responsibilities:- Work 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.
- Report findings and results to promote a strong risk and control environment, Risk & Reserving committees, senior leaders, and other key stakeholders as required.
- Support the development of claims technical file review audit methodology framework and processes.
- Provide input and insight in developing the annual audit plan.
- Support the development of audit quality standards for each step of the audit process, including testing scripts and interpretation notes, working papers, etc.
- Complete file reviews.
- 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 (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.
- 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.
- Experience as a claims leader is an asset 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 to help foster a positive compliance culture.
- Proficient in Excel, PowerPoint, and Word.
- Strong organizational and problem-solving skills with the ability to gather information, analyze critically, and cut through complexities to arrive at workable solutions.
- 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).
Definity is an inclusive work environment that welcomes diversity and supports accessibility. If you require accommodation at any time during the recruitment process, please let us know by contacting us.
This role requires successful clearance of background checks (including criminal checks and leadership references).
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