Claims Quality Assurance Specialist

3 days ago

Québec, Quebec, Canada Definity Full time
Job Summary

We are seeking a highly skilled Claims Quality Assurance Specialist to join our team at Definity. As a key member of our Governance and Compliance department, you will play a critical role in ensuring the quality and integrity of our claims handling processes.

Key Responsibilities
  • Lead the implementation and execution of a technical file review program within the claims area of the business, covering multiple regions and jurisdictions.
  • Develop and maintain a strong risk and control environment, working closely with Claims VPs and Directors, Actuarial and Insurance Risk teams.
  • Report findings and results to promote a strong risk and control environment, and to 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.
  • 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.
  • 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.
  • 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 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 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, 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.
Requirements
  • 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).

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