Claims Quality Assurance Specialist, Governance
4 weeks ago
This role is responsible for leading the implementation and execution of a technical file review program within the claims area of the business, ensuring compliance with regulatory requirements and adherence to company standards.
Key Responsibilities:- Develop and implement a technical file review program to ensure claims file handlers and leaders meet customer expectations, manage claims according to regulatory requirements, and adhere to company standards.
- Work with Claims VPs and Directors, Actuarial and Insurance Risk teams 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/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 (Claims Leaders, Claims Technical Advisors, Claims Quality Assurance) are calibrated for a consistent approach in auditing claims files.
- 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.
- 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 and diverse company that values accessibility and supports employees with disabilities. We offer a hybrid work schedule, company share ownership program, pension and savings programs, paid volunteer days, and educational resources. Our company culture emphasizes inclusion, diversity, and equity, and we strive to create a positive work environment for all employees.
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Claims Quality Assurance Specialist, Governance
4 weeks ago
Québec, Quebec, Canada Definity Full timeJob DescriptionThe Claims Quality Assurance 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, manage claims according to regulatory...
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