Sr. Specialist, Quality Assurance , Claims

Job Description

Overview

The Sr. Specialist, National Claims Quality Assurance will engage in the execution of a technical claim’s quality program within one area of the claims business. This Line 1B defence mechanism for Claims ensures our claims handlers and leaders are:

• Meeting customer expectations
• Ensuring case reserves are timely and accurate
• Managing claims according to regulatory requirements
• Adhering to file handling practices and SLA's to Definity standards

The individual will support the improvement, and monitoring of the Claims Quality Assurance methodology and framework. The role is also accountable for providing technical support, direction and guidance for Claims Services. In collaboration with the Manager, Claims Governance, the Sr Claims Quality Specialist will assist with quality control, technical training & trending analysis by incorporating data analysis to measure and monitor adherence to regulatory and company standards of the Claims Services portfolio. This also includes management and quality assurance of business line specific vendor programs, monitoring emerging risks to improve the organization's ability to identify, assess, mitigate, govern and report. The role is also responsible for tracking and monitoring claims issues, and their associated mitigation plans to completion, including testing for effectiveness.

What can you expect

• Develop and build Trusted partnership with designated Claims Directors and Managers and work with Actuarial and Insurance Risk teams - within their areas of expertise (e.g., Accident Benefits, Bodily Injury, Auto PD, Property)
• Manage calibration and oversight of Claims leader/Claims Technical Advisor reviews (Technical File review) by:
  • Ensuring all reviewers (Claims Leaders, Claims Technical Advisors) are calibrated to ensure consistent approach in auditing claim files
  • Performing double reviews
• Foster awareness of the company's policies and procedures through regular communication, training and employee engagement
• Collaboration with internal governance teams
• Ongoing collaboration with Learning & Development and Transformation teams
• Work with Claims, Vendor Management, Actuarial, IT, Legal & Compliance, Privacy, Ombudsman’s office, Finance, Underwriting, External Claims Partners, and Second & Third Lines of Defence
• Provide strategic input through collaboration with the internal controls team to support the claims operations on their Risk & Control journey to best in class
• Assist with the implementation of new requirements, controls, close action items as needed, including assisting with new regulatory requirements, process and controls mapping/documentation, framework updates and/or development
• Develop techniques to make control testing more efficient and effective

What do you bring

• 10+ years of claims experience including 5+ years of claims handling experience
• Strong technical experience in 2 or more of the following lines of business; Accident Benefits claims, Auto claims, Property claims, or BI/Casualty claims
• University Degree/College Diploma or an appropriate level of experience
• Strong understanding of business operations and related legislative, regulatory and internal policy and procedure requirements
• Experience in audit, risk management, regulatory compliance, processes and controls
• Proficient in Excel, PowerPoint and Word
• Leadership Experience preferred
• Bilingualism is an asset
• Strong level of personal integrity
• Highly Positive attitude and open minded
• Thrives in a team environment and ability to work independently

Salary Range : $77,800- $129,600