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Senior Claims Quality Assurance Auditor in Sun Prairie at QBE

Date Posted: 10/23/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Sun Prairie
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/23/2018

Job Description

Provides visibility into claims quality through review of open and closed claim files against Claim Handling Guidelines and policies and procedures. Provides suggestions for improvement opportunities.

Primary Responsibilities

•             Responsible for providing all Audit functions across the Claims organization

•             Evaluate Claims files against established Claim Handling Guidelines and policies and procedures for accuracy

•             Aggregate results for all QA Audit measurements performed and share with key business leaders in the Claims Technical team

•             Develop calibration measurements, score cards, action plans and best practice methods to mitigate risks in the claims handling process

•             Develop the QA questionnaires that will be used, and coordinate those efforts with the Claims Technical team to ensure process improvements are documented and accurately captured

•             Coordinate review of Claim Handling Guidelines as needed, and to support the continuous improvement efforts of the operation

•             Manage Governance of QA process, including, but not limited to, handling appeals, approving and monitoring action plans, delivering results to senior leadership, managing escalations, leading calibration sessions, 

•             Coordinate Re-review (R2) and Re-testing of claim files and action plans and report on results and improvement recommendations.

•             Lead test of design and test of efficiency for Model Audit Rule annual review of QA governance.

•             Takes lead role in audit planning and risk analysis; gathers documentation necessary to an understanding of the risks associated with the business subject to review; works with internal and external business partners to clearly define audit scope and select appropriate test sample; coordinates resources and logistics as needed to efficiently complete audit

•             Provide subject matter expertise, support and guidance to customers concerning all QA tools and processes, including results analysis, Teamthink reports and questionnaires and interpretation and application of claim handling guidelines

•             Build and enhance individual development and skill-set by seeking educational opportunities, participating in available training and researching innovative technology and methodologies to provide strong departmental support

•             Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun

•             Adopt QBE values in personal work behaviors, decision-making, contributions and interpersonal interactions; manage own career development by soliciting feedback and valuing other perspectives.

Required Qualifications

Bachelor’s Degree or equivalent combination of education and work experience.

Preferred Qualifications

Knowledge

Working knowledge of claims insurance industry products and services

•             Working knowledge of quality assurance procedures and continuous improvement techniques and principles

•             Working knowledge of database systems, applications and technology relevant to area of responsibility

•             Working knowledge of Microsoft Outlook, Word, Excel and Access

•             Working knowledge of test and inspection method

Skills

•             Effectively communicate ideas to key stakeholders to influence adoption of innovative solutions.

Abilities

•             Analyze and synthesize data to form options and recommendations

•             Conduct tests and inspections of services or processes to evaluate quality or performance

•             Ability to anticipate obstacles and challenges, identify root cause and strategize plans to address

•             Manage and prioritize competing responsibilities concurrently and effectively

•             Conduct gap analysis of current state and desired future state

Work Environment

General office jobs

Work is generally performed in an office environment in which there is not substantial exposure to adverse environmental conditions. Must have the ability to remain in a stationary position for extended periods of time. Must be able to operate basic office equipment including telephone, headset and computer. Incumbent must be able to lift basic office equipment up to 20 pounds.

Number of Openings:

1

How to Apply:

To submit your application, click "Apply" and follow the step by step process.

Equal Employment Opportunity:

QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.

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The companies of QBE North America are committed to equal employment opportunities. All qualified applicants will receive consideration for employment without regard to age, disability, marital or parental status, national origin, citizenship, race, color, religion, sex, sexual orientation, or veteran status. All personal information contained in this application will be kept confidential as required by law.