Director/VP of QA Claims Florida (P&C Insurance Carrier)

1) Must have Active FL 620 license in good standing and the ability to obtain adjuster licenses in all states where client conducts business

2) Our client is hiring either a Director, Sr. Director, or VP level.

3) Must have heavy P&C experience on the carrier side.

The Director of QA will work collaboratively across all teams and all departments within the insurance carrier acting as a catalyst for change and enhanced claims performance and quality. The Director will develop claims QA policies, procedures and standards. The Director will oversee all claims QA operations and manage the QA staff. The Director will collaborate with claims management to evaluate, determine and devise training needs for the claims department.

Technical expert responsible for developing and implementing quality assurance standards ensuring adherence to departmental and corporate guidelines. Drive continuous improvement through the establishment and implementation of quality metrics and customer experience enhancements. Monitor deficiencies and implement solutions to close gaps and mitigate risk.

Analyzes and reviews claims for accuracy, completeness and quality claims handling. Familiar with standard concepts, practices, and procedures within the claims industry

• Directs the development, maintenance and enhancement of quality assurance standards and procedures.
• Serves as department expert relative to the correlation of data obtained from file reviews.
• Provides direction and guidance to others in relation to quality and control standards.
• Individually performs or leads project teams in conducting technical file reviews advising senior management of issues and trends.
• Manages and maintains departmental Quality guidelines for an operational area.
• Guides and trains new staff regarding compliance with departmental guidelines.
• Monitors and gathers information necessary to identify and analyze emerging trends as they relate to assigned functional and operational areas.
• Stays current on industry trends and developments.
• Establishes the review process for closed claim file audits.
• Serves as subject matter expert for all claim lines of business regarding quality root cause analysis and action plans to improve standards across business lines.

Serves as Project lead and Quality Expert for implementation of new vendor technologies

Leads Change Management Implementations including benefits analysis

Audit complex residential and commercial open claim files for accuracy and completeness and to assure company and State required guidelines are followed.

Record results of open claims audits and present findings in meetings with Management and Adjusters.

Perform analysis, identify trends, and provide recommendations to improve technical and procedural aspects of claims handling

Identify Adjuster coaching opportunities and communicate findings to management.

Participate in claims management calibration sessions to evaluate and discuss quality compliance and departmental training needs.

Responsible for developing and organizing training materials, multimedia visual aids, and other educational materials.

• Ensures adherence to overall Claims Performance Goals in 3 key areas: Customer Service, Quality Claims Handling and Efficiency.
• Perform other essential duties as assigned.

• A solid understanding of the insurance carrier industry, its products, practices and more generally the role of Quality Control and Assurance across Operations.
• Advanced analytical and problem- solving skills with ability to manage and prioritize multiple projects.
• Excellent project management skills.
• Excellent communication presentation and interpersonal skills with the ability to work effectively with both internal and external business partners and communicate effectively with individuals across all levels of the organization.
• Experience leading project teams and the ability to coach and mentor staff at all levels.
• Ability to influence others in accepting ideas that will lead to increased business results.
• Strong computer skills including MS Office suite and other business related and/or project management software systems.
• Individual must have high level of interpersonal skills to handle sensitive and confidential situations
• Position continually requires demonstrated poise, tact and diplomacy.

Work requires continual attention to detail in composing, typing and proofing materials, establishing priorities and meeting deadlines. The individual must be able to work in a fast-paced environment with demonstrated ability to handle multiple tasks and demands.

EDUCATION AND /OR EXPERIENCE

Bachelor’s degree desired, or equivalent work experience required.

10+ years of property coverage at the carrier level.

Previous property claims management experience

Active FL 620 license in good standing. Ability to obtain adjuster licenses in all states where client conducts business

Applicable professional designations preferred