Claims Quality Assurance Leader
Job Locations US-United States
Requisition ID
JR1003453
Category
Claims - Specialty Lines
Position Type
Regular Full-Time
Overview
Objective
To oversee, enhance, and ensure the quality and accuracy of claims processing, contributing to operational efficiency, compliance, and customer satisfaction.
Scope of Work
The Claims QA Leader will be responsible for developing and implementing quality assurance processes for AmTrust's internal and TPA claims operations. They will oversee audits, analyze trends, and collaborate with teams to improve accuracy, compliance, and efficiency in claims processing.
Responsibilities
Quality Assurance Oversight
Develop and implement quality assurance (QA) standards and best practices for claims handling alongside our claim leaders.
- Monitor and evaluate the accuracy of claims adjudication, identifying discrepancies and leakage.
Auditing and Compliance
Conduct routine and ad-hoc audits to ensure compliance with regulatory and organizational standards.Report audit findings and prepare actionable reports for leadership.Create calibration process to ensure standards are equally measured.Training and Development
Create training programs and materials to address performance opportunities identified through audit.Mentor and coach claims staff on quality assurance protocols and best practices.Develop training to address and cut down on leakage.Performance Monitoring
Establish and track key performance indicators (KPIs) for claims quality.Collaborate with teams to set realistic goals and track progress over time.Process Improvement
Analyze claims data to identify trends and areas for improvement.Work with cross-functional teams to recommend and implement process enhancements.Stakeholder Communication
Act as the primary liaison between QA and claims department teams to resolve issues.Present QA findings and improvement initiatives to leadership and stakeholders.Ability to drive best in class claims handling results through collaboration with department heads.Goals and Benchmarks
Short-Term Goals (First 3-6 Months)
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data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="2" data-aria-level="1">Develop and implement a audit framework for claims handling.li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Conduct baseline audits to establish performance metrics.li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="4" data-aria-level="1">Train claims staff on QA processes and compliance requirements.Medium-Term Goals (6-12 Months)
li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="5" data-aria-level="1">Achieve a claims audit score of 90% or higher.li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="6" data-aria-level="1">Identify and address the recurring quality issues in claims handling.li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="7" data-aria-level="1">Reduce leakage rate by at least 5% through targeted training and process improvements.Long-Term Goals (12 Months)
li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="8" data-aria-level="1">Maintain a consistent claims accuracy rate of 90% or higher.li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="9" data-aria-level="1">Achieve a leakage rate of less than 3%.li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="10" data-aria-level="1">Implement advanced analytics tools for QA monitoring.Deliverables
Quarterly QA performance reports, including trends, benchmarks, and actionable recommendations.Comprehensive training materials for claims teams.Updated QA protocols and workflows.Action plans to address recurring claims processing errors.Performance Evaluation
Success in this role will be measured by :
li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="11" data-aria-level="1">Achievement of defined accuracy and compliance benchmarks.li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="12" data-aria-level="1">Reduction in claims leakage.li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="13" data-aria-level="1">Positive feedback from internal teams and stakeholders.li style="margin : 0px 0px 0px 24px; padding : 0px; font-size : 11pt; font-family : Georgia, Georgia_MSFontService, serif;" data-leveltext="
data-font="Georgia" data-listid="8" data-list-defn-props="{"335551671" : 0,"335552541" : 1,"335559685" : 720,"335559991" : 360,"469769226" : "Georgia","469769242" : [8226],"469777803" : "left","469777804" : "469777815" : "hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="14" data-aria-level="1">Consistent delivery of actionable insights and process improvements.Qualifications
Thorough understanding of laws, principles of coverage, liability and insurance industry in general.Analytical and human relations skills are critical.Leadership skills; ability to plan, organize, delegate and develop staff.Effective communication skills; ability to obtain and deliver information to others orally and in written form.Ability to work with little supervision and direction.Ability to operate business technology.College degree or 10 years equivalent experience and skills required.LI-BL1
LI-REMOTE
AmTrust
What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include : Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
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