Claims Quality Assurance Representative - SR. (Desk Auditing)

  • Full-time

Company Description

A career at Citizens is unlike a career at any other insurance company, because Citizens is unlike any other insurance company.

If you are looking for an opportunity in which you can stretch to your full potential, expand your knowledge and grow your career, you have found it.

Winner of the 2017 WorldatWork Seal of Distinction, one of only seven companies throughout Florida to receive this award, Citizens is a diverse team of professionals helping people and communities throughout Florida.

At Citizens, employees do more than live up to their potential – they exceed it.

So what are you waiting for? Come discover the career you never expected – at Citizens.

Job Description

POSITION SUMMARY: This position serves as the Quality Assurance technical expert for the Claims Operations by auditing the claims processes including coverage analysis, investigation, valuation, reserving, and accurate disposition of claims. This position is also responsible for providing audit results reporting and feedback, as well as for leading training development and delivery. This position mandates successful completion requirements of Fundamental Claims School, which includes obtaining an overall passing score.

ESSENTIAL FUNCTIONS: THE FOLLOWING ARE THE USUAL, BASIC AND ESSENTIAL FUNCTIONS OF THE POSITION. THESE FUNCTIONS ARE NOT TO BE CONSTRUED AS AN EXHAUSTIVE LIST OF ALL RESPONSIBILITIES, DUTIES, AND SKILLS REQUIRED.

·         Model ethical behavior and execute job responsibilities in accordance with Citizens core values, ethics, and information protection policies.

·         Serve as QA lead and coach to QA team peers and other team members. Also serve as technical QA lead to various claims units as needed.

·         Lead QA department projects and serve as primary coordinator on these to senior leadership.

·         Support the Claims Quality Assurance Program in developing and implementing quality improvement strategies.

·         Conduct claim file audit reviews, field re-inspections throughout the state of Florida, field Quality Assurance trainings at remote locations, and other quality assurance projects as needed.

·         Provide feedback to QA leadership on QA projects, business reporting, inter-departmental, on claim quality audit results and make recommendations for improvements.

·         Determine, monitor and analyze measurements; conduct trending analysis; identify leakage; and prepare objective reports. Also, provide claims-related information to the Claims Quality Assurance management.

·         Lead the creation, presentation, execution and calibration of Quality Assurance training sessions. This includes integrating and delivering property claims training programs in the context of Quality Assurance calibration exercises (e.g. policy, estimatics, systems, workflows, statutes) and taking steps toward target results and the acquisition of target skills-sets. This also includes the creation, maintenance and update of of quality assurance training materials as necessary for use in quality assurance training sessions.

·         Contribute to the development of process-specific, competency-based education programs as necessary in conjunction with the Insurance Operations training team that will include train the trainer and end-user programs.

·         Participate in co-inspections with staff and external business partners as needed.

·         Serve as technical QA face to face contact with customers, staff, and external business partners.

·         Identify new technology and other resources to achieve greater efficiency and improved results.

·         Perform market research for products/services and provide analytical reports.

·         Assist the Claims Organization to assess the need for, and create specific Quality Assurance training for staff, independent adjusters and vendors within the Claims Organization.

·         Participate in Catastrophe responses, as needed.

·         Participate in the Quality Assurance Re-inspection Programs, which involves physical re-inspections of damaged properties throughout the state of Florida, as needed.

·         May coach, counsel or train less-experienced staff, may also direct the work of others, may provide input in the performance management, goal setting and review processes

Qualifications

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

·         Strong leadership and project management skills.

·         Expert proficiency in Microsoft Office Word, Access, Excel, Outlook, and Internet navigation.

·         Strong ability to effectively communicate verbally and in writing, to include presentation skills and the ability to communicate at all levels the organization and with external parties such as contractors.

·         Advanced knowledge of Quality Assurance (QA) and training principles.

·         Ability to plan, prioritizes workload, organize and coordinate multiple tasks and projects.

·         Strong problem-solving and analytical skills.

·         Ability to translate technical data into user-friendly documentation, training materials, process flows, etc

·         Advanced knowledge of construction and repair methodology, understanding of building codes, Xactimate estimating software, and ability to converse with contractors.

·         Ability to conduct field inspections of damaged property, including roof inspections.

·         Ability to work independently and manage a high volume of assignments.

·         Ability to maintain effective working relationships with claims management, staff and external business partners.

·         Ability to work in a fast paced and flexible work environment.

·         Ability to travel up to 25% of the time.

REQUIRED EDUCATION AND EXPERIENCE:

·         Associate’s degree OR two (2) years relevant experience OR a combination of college education and experience equivalent to two (2) years.

AND

·         Eight (8) or more years of property insurance claims experience, four (4) years of which should be in field property claims or in area with skills transferrable to position, two (2) or more years of claims file audit or file review experience or two (2) or more years of claims field re-inspection experience

·         Strong experience with hands-on training development and presentation.

·         Must possess a valid, active and appropriate Florida adjuster license within 90 days of employment and maintain it as a condition of continued employment. Appointment required.

·         Within 90 days of employment, must successfully complete all requirements of Citizens’ Fundamental Claims School, which includes obtaining an overall passing score.

 

PREFERRED QUALIFICATIONS:

·         Bachelor’s degree in field with skills transferrable to insurance.

·         Ten (10) or more years P&C Insurance claims experience, six (6) years of which should be in field property claims or area with skills transferrable to position.

·         Four (4) or more years of claims quality assurance or file audit experience OR four (4) or more years of claims quality assurance field experience or field re-inspection experience.

·         Three (3) or more years with Alternative Dispute Resolution claims experience.

·         One (1) or more years with sinkhole (earth movement) claims experience.

·         Experience in NFIP flood claims handling.

·         Experience with building methods and materials, as well as local building damage repair procedures and ordinances.

·         Active Florida Adjuster license (620 or 644)

·         Experience with Citizens CTS or equivalent electronic claims management system.

·         Comprehensive knowledge of Xactimate / XactAnalysis estimating program.

·         Insurance Designations (AIC, CPCU, CLU, ChFC, ARM, INS)

·         English/Spanish bilingual skills

 

PHYSICAL REQUIREMENTS:

This position requires the ability to sit, hear, converse over the telephone and key frequently on a computer for long periods of time (4 or more hours per day). Position requires the ability to be mobile, operate a motor vehicle, climb roofs and inspect homes including attics & crawl spaces. This position may require occasional overnight travel during catastrophe response; and may be required to work for extended periods of time to include after standard business hours in addition to weekends and holidays during catastrophe response, or as needed.

Additional Information

In addition to a competitive salary, Citizens offers its employees an outstanding total rewards package, including:

ü  Retirement savings plan with an 8 percent company match

ü  Medical, dental and group life insurance

ü  Paid time off: vacation, sick and holiday leave

ü  Tuition reimbursement

ü  Professional and leadership development opportunities

ü  Flexible work schedule

ü  On-site wellness activities

ü Employee recognition programs

ü  Relocation assistance (where applicable)

ü  Community and volunteering opportunities

ü  Casual dress and more

Citizens is proud to be an Equal Opportunity Employer

Relocation Assistance is not available for this position.