Claims Quality Assurance Specialist

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SUMMARY

The Quality Assurance Specialist serves as a resource and is responsible for the creation, development and administration of consistent reviews of claim files. This position also analyzes the data from claim file reviews, compiles related reports and assists in training.

ESSENTIALDUTIESANDRESPONSIBILITIES include the following. Other duties may be assigned.

• Exemplify professional and ethical behavior
• Create, develop and administer consistent Quality Assurance reviews of claim files
• Analyze the handling, investigation, coverage application and payments of claims
• Compile metrics and trends regarding claim handling and translate into user-friendly documentation
• Recommend processes for greater efficiency and improved claim handling
• Identify and recommend training needs for the Claims Department
• Work with the Claims Trainers to develop targeted training
• Promote consistency of claim handling
• Collaborate with other members of the Claims Department and other departments in the organization
• Monitor and evaluate claim handling
• Timely completion of assigned tasks and projects
• Maintain knowledge and compliance of company procedures, claim related statutes and insurance regulations and other legal requirements · High level of customer service for internal and external clients/partners
• Contribute to the goals and objectives of the Team and the organization

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand and walk. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

SUPERVISORYRESPONSIBILITIES

This position has no supervisory responsibilities.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Strong organizational and task management skills. Strong relationship management and proven experience delivering high level if internal and external customer service. Computer proficiency with strong skills in Microsoft Office applications. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience

• Bachelor's degree
• Florida 520/620 Adjuster License
• Ability to obtain adjuster licenses in Alabama, Georgia, North Carolina and South Carolina as well as any other states required within 90 days of hire date
• Minimum of 7 years of property insurance claims experience; field claim handling and/or Quality Assurance experience is preferred

Knowledge, Skills and Abilities:

• Exceptional oral and written communication skills
• Knowledge and understanding of claim related statutes and applicable insurance regulations and legal requirements
• Comprehension of policy contracts and proper application of policy coverages
• Organizational and time management skills
• Flexible in handling multiple tasks
• Self-motivation
• Sound judgment and decision making abilities
• Strong working knowledge of Xactimate, XactAnalysis, XactContents, Adobe and Office 365 programs such as Outlook, Word, Excel, Microsoft Teams, PowerPoint and Power BI
• Prior knowledge and experience in the use of Guidewire is beneficial
• Advanced knowledge of construction and repair methods
• Ability to read, write and comprehend instructions and correspondence
• Ability to add, subtract, multiply and divide in all units of measure using whole numbers, common fractions and decimals
• Ability to compute rate, ratio and percentage and to draw and interpret bar graphs
• Ability to apply common sense understanding to carry out instructions

LANGUAGE SKILLS

Must possess the ability to read and comprehend detailed instructions, correspondence, and memos as well as write simple correspondence. Must also be able to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

MATHEMATICALSKILLS Must be proficient with the following: addition, subtraction, multiplication, and division in all units of measure, using whole numbers, common fractions, and decimals.

REASONINGABILITY

Must be able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Must also be able to deal with problems involving several concrete variables in standardized situations.

CERTIFICATES,LICENSES,REGISTRATIONS

Preferred but not required: 620 or 520 license, six sigma, training certifications, claims designations, Xactimate certifications.

PHYSICALDEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand and walk. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

NOTE: This is not necessarily an exhaustive list of responsibilities, skills, duties, requirements, efforts or working conditions associated with the job. While this list is intended to be an accurate reflection of the current job, Frontline Insurance reserves the right to revise the functions and duties of the job or to require that additional or different tasks be performed when circumstances change.

I have carefully read and understand the contents of this job description. I understand the responsibilities and duties expected of me. I also understand that this job description does not constitute a contract of employment nor alter my status as an at will employee. I have the right to terminate my employment at any time and for any reason and Frontline Insurance has a similar right.

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