Job Details

Claims Quality Assurance Supervisor

The Claims Quality Assurance Supervisor leads a team of Quality Assurance Representatives or Quality Analysts. This role is responsible for reviewing claim files for accuracy, compliance with policies and procedures, as well as CA Department of Insurance guidelines. This role will also include managing communications with the Department of Insurance as well as assisting with coverage analysis for Claims Examiners.

Principal Duties & Responsibilities

• Assist the Claims Quality Assurance Manager in managing and leading the Quality Assurance Department.
• Collaborate with and support Claims Quality Analysts and QA Representative teams to maintain the daily workflow across the Quality Assurance Department.
• Hire, train, and coach Quality Assurance Representatives and Claims Quality Analysts.
• Provide file data for file reviews and maintain the audit platform.
• Direct and oversee file reviews and Department of Insurance complaint responses.
• Provide feedback/results/trends to Claims Examiners, Supervisor, Managers, and Claims Quality Manager based on review results and findings and make recommendations for training or improvement.
• Review, analyze, and provide suggestions for claim handling practices handled by Desk Examiners and Independent Adjusters. Review repair estimates for technical accuracy and adherence to industry/CFP guidelines/standards, as well as client requirements.
• Compile estimate revision requests and coordinate with network contractors to obtain estimate corrections.
• Verify file documentation is included for completion of the review process.
• Create and maintain workbooks, questionnaires, processes, and training materials to promote accuracy and consistency.
• Take lead on various projects, including but not limited to QA software and report implementation.
• Manage CEA Liaisons and support CEA training and reporting.
• Adhere to Federal and State laws and regulation.
• Any other duties needed to help fulfill the Associations Mission, abide by the Association's Values, and fulfill the Association's Strategic Objectives.

Education & Experience

• Bachelor's degree or equivalent preferred.
• Strong knowledge of property claims. Minimum of 5-10 years' property insurance claims experience, 2+ years of Quality Assurance experience and 1 year of supervisory experience.
• Strong organizational, file management and time management skills.
• Attention to detail; ability to prioritize and strong decision-making skills.
• Excellent written and oral communication skills.
• Adaptability and demonstrated ability to manage change.
• Working experience with MS-Office (especially Word and Excel) is required.
• Proficient in the Xactimate estimating program.
• Certified in CEA and Fair Claims Settlement Practices.