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Bilingual Senior Claims Quality Assurance Specialist
2 months ago
We are seeking a highly skilled and experienced Claims Quality Assurance Specialist to join our team at Definity Financial Corporation. As a key member of our Claims department, you will play a critical role in ensuring the quality and accuracy 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 by reporting findings and results to senior leaders and key stakeholders.
- Support the development of claims technical file review audit methodology framework and processes.
- Make recommendations on findings and agree with key claims stakeholders to manage risk.
- Recommend and influence 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.
- Work with Claims, Actuarial, Risk, IT, Legal & Compliance, Finance, and Underwriting teams.
- Foster awareness of company policies and procedures through regular communication, training, and employee engagement.
- Help implement new requirements, controls, and close action items as needed.
- Monitor emerging best practices in risk management, audit, and control.
- 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 foster a positive compliance culture.
- Proficient in Excel, PowerPoint, and Word.
- Bilingualism is mandatory (French/English).
