QA Claims Analyst

QA Claims Analyst – Must Have Claims Adjusting Experience

Work-From-Home

Comprehensive Benefits Package

• Medical, Dental, Vision Insurance Effective on Start Date – no waiting period

• Paid Time Off Program

• 401k

• And Much More

Quality Assurance Claims Analyst with Claims Adjusting Experience (Auto, Property, General Liability, Workers Compensation) Needed for Premier Third-Party Administrator

Job Description

Assist Quality Assurance team with file audits, oversight of DOI complaint logs, company audits, and other miscellaneous projects. Define and maintain Best Practices, refining them as new case law, regulations or innovate approaches come to light.

Essential Duties and Responsibilities:

· Claim and Phone Audits: Utilize NARS’ proprietary auditing software, SCORE! to provide basis of technical scores for ongoing improvement and performance evaluations by identifying areas of opportunity for targeted improvement/development.

· Coordination and assistance with SSAE 16 compliance and external insurers, reinsurance, MGA’s or regulatory agency audits and results. Aid in collection of information needed for our clients undergoing an audit and providing access, credentials, and training, as necessary.

· Attendance of Wrap-Up Meetings: Attend meetings to help identify both individuals and issues for training and publication of results and action plans.

· Regulatory Agency and Service Complaints: Assist carrier partners and Claims personnel on complaint investigation, response, and complaint logs. Objectively investigate and draft proposed response and communicate with the client for approval. Ensure timely and proper responses filed, and corrective action is taken, if required.

· Maintenance of claims system data, auditor credentialing, changes to template letters, auto assignment rules, and changes due to client program, location, and duplicate claims.

· Testing of processes and systems to ensure quality control and efficiency.

· Create and maintain NARS Best Practice Guidelines and Workflow Process Diagrams.

· Miscellaneous assigned duties and projects as issued by management.

Qualifications:

Education / Licensing:

· High School Diploma or equivalent required, 2-year degree or higher preferred.

· 3+ years of claims adjusting experience.

· Must possess a current Florida Adjusters license and required jurisdictional licensing.

Technical Skills:

· Must be genial and have a high level of interpersonal skills to handle complex, sensitive, and confidential matters with patience, objectivity, and diplomacy.

· Must possess strong customer service skills along with critical analysis of trending, problem solving analysis and correction planning skills.

· Previous negotiation and litigation skills preferred, but not necessary.

· Must be able to work independently and possess excellent written and verbal communication skills.

· Advanced knowledge of a variety of computer software applications in word processing, spreadsheets, database, and presentation software. (Microsoft Office platform.)

Abilities:

· Ability to travel when needed.

· Requires long periods of sitting

· Requires working indoors in environmentally controlled conditions

· Requires lifting of files and boxes up to approximately 20 pounds

· Repeated use of keyboard, mouse, and exposure to computer screen

In the spirit of pay transparency we are excited to share the base salary for the position of Quality Assurance Analyst is $53,730 -$78,620, exclusive of fringe benefits or potential bonuses. This position is also eligible for an annual performance raise if all guidelines are met. Your salary compensation will be determined based on factors such as geographic location, skills, education and or experience. In addition to those factors, we believe in the importance of pay equality and consider internal equality of our current team members as a final part of any offer. Please keep in mind that range mentioned above is full base salary range for the role. Hiring at maximum of the range would not be typical in order to allow future and continued salary growth. We also offer a generous compensation and benefits package.