POSITION SUMMARY
The Claims Quality Assurance Supervisor leads a team of Quality Assurance Representatives or Claims Quality & Subrogation Analysts. This role is responsible for reviewing claim files for accuracy, and compliance, with the CA Department of Insurance (CDI) Fair Claims Settlement Practices Regulations. This role will also manage communications with the Department of Insurance and assist claims examiners with coverage analysis.
PRINCIPAL DUTIES & RESPONSIBILITIES
- Collaborate with Claims Quality & Subrogation Analysts and QA Representative teams to maintain the daily workflow across the Quality Assurance Department.
- Develop and implement quality assurance policies, procedures, and workflows that promote consistency, efficiency, and delivery of high-quality service.
- Hire, train, mentor, and support Quality Assurance Representatives and Claims Quality & Subrogation Analysts
- Provide file data for file reviews and maintain the audit platform.
- Direct and oversee file reviews and manage responses to complaints filed with CDI.
- Provide feedback to team members regarding auditing accuracy and CDI response letters.
- Provide feedback and results/ on findings and make recommendations for training and improvement.
- Manage monthly file audit calibrations and provide summary of the results to ensure consistency
- Review, analyze, and provide suggestions for claim handling practices
- Review repair estimates for accuracy and adherence to industry/CFP guidelines, and client requirements.
- Compile estimate revision requests and coordinate with network contractors to obtain estimate corrections.
- Create and maintain workbooks, questionnaires, processes, and training materials to promote accuracy and consistency.
- Lead various projects, including but not limited to QA software and report implementation.
EDUCATION & EXPERIENCE
- Bachelor’s degree or equivalent preferred.
- Strong knowledge of quality assurance and property claims.
- Minimum of 5-10 years property insurance claims experience, 2+ years of supervisory experience.
- Strong organizational, file management, and time management skills.
- Attention to detail; ability to prioritize and make strong decisions.
- Excellent written and oral communication skills.
- Adaptability and demonstrated ability to manage change.
- Working experience with MS-Office is required.
- Proficient in the Xactimate estimating program.
- Certified in CEA and CA Fair Claims Settlement Practices Regulations.
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