Quality Assurance Specialist
- Career Level
- Experienced (Non-Manager)
At Windhaven Insurance we are always looking for A-players who want a challenge. Are you a driven person who wants to achieve great feats of growth in an environment that feels more like a successful start-up than an insurance company? Then you might be a future Windy.
The QA Specialist will be responsible for reviewing of first party and/or third party auto claims to determine compliance with regulatory and organizational best practices and procedures. This involves reviewing policy language, loss information and all related claim documentation associated with a reported claim. The candidate will analyze trends, identify process improvement opportunities and document audit results in an effort to enhance departmental processes and performance. The candidate must possess strong analytical and problem solving skills.
Job Requirements/ Qualifications:
- Conduct comprehensive claim file reviews, identify opportunities for efficiencies and improvements and summarize results for delivery to management.
- Analyze and interpret departmental metrics including coverage application, financial accountability, and customer service.
- Document and implement QA standards, processes & methodology.
- Ensure ongoing compliance with state and national standards and legislation.
- Communicate with management to ensure full understanding of financial and operational objectives, risks, controls and observations.
- Assist in the ongoing design, modification and implementation of the claims quality review program.
Education and Experience:
- Must have a Valid 620 License
- Preferably 5-7 years’ auto insurance claims experience
- Preferably 1-2 years estimating/appraisal experience; Evaluating/Writing estimates
- Bachelor’s degree required
- Property and Casualty insurance industry and claim handling experience
- Expertise with coverage and liability investigations with an emphasis in Florida handling
- Experience in evaluating bodily injury claims
- Sound organizational and planning skills with a solid attention to detail
- Solid verbal and written communication skills with an emphasis on confidentiality, tact, and diplomacy
- Proficiency in using Microsoft Office Package (Excel, Access, PowerPoint, Word).