Summary: the srQa, compliance, and litigation specialist is an integral member of the corporate & legal department of the company, and primarily focuses on claims-related matters, but knowledge of underwriting and product is desirableThe successful candidate is someone who is passionate about compliance, quality assurance, and in working cross-functionally to continuously improve processesThe successful candidate is also someone with experience in handling litigation matters and managing outside counselThe candidate will be responsible for conducting compliance/regulatory, operational, and financial reviews in all areas of the claims process to assess the quality of policies, procedures, supervision, handling, vendor-contracts, internal reports, management reports, internal controls and protocols, and inter/intra-departmental relations and communicationsThe candidate will collaborate with the learning and development manager in providing policy and audit tool training to new and contract claim department hiresThe candidate will manage and respond to claims consumer complaints, and extra-contractual, excess of loss, and direct-action casesThe candidate will also provide updates to the claims team during market or department meetings outlining trends and sharing proactive recommendations for reducing complaints in this areaEssential functions/principal responsibilities:
Conduct and manage all aspects of the claims audit tool and program with an eye towards continuous improvement and achievement of business results
Collaborate with director of qa & compliance in preparation and rollout of focus audits and facilitation of audit discussions
Evaluate claims operating systems to determine efficient and effective functionalityOffer objective recommendations for process improvement
Evaluate compliance with claims department policies, procedures, and protocols, and offering objective recommendations for process improvement
Evaluate the quality of all claims guidelines and protocols and offer recommendations for process improvement
Evaluate the quality of legal servicesConduct audits to verify adequacy of file handling, settlements, and compliance with internal controlsOffer recommendations for process improvement.
Handle and respond to consumer complaints relating to claims
Responsible for intake, review, and communication with defense counsel in management of direct-action complaints as well as management of legal and indemnity expenses
Provides regular updates to svp, general counsel and director of qa & compliance outlining a proactive case strategy and recommendations for case direction with creative resolutions
Maintain individual expertise by staying abreast of industry trends, reviewing industry periodicals, publications, especially, all operating states doi legal/regulatory changes
Collaborate with svp, general counsel and director of qa & compliance in preparation of training for business areas and presentation of training topics throughout the year
Knowledge, skills, and behaviors:
Thorough knowledge of claims policies, procedures, and protocols in all disciplines; fair/unfair claims practices regulations, all operating states insurance codes and contracts, civil codes, vehicles codes, arbitration rules and regulations, and legal decisions
Litigation management experience and knowledge
Proficient in excel, powerpoint, performance and kpi reporting, and analysis of information and data
Excellent written and oral communication and training skillsMust be able to effectively communicate with field claims personnel, executive management, vendors and others, necessary to accomplish goals.
Demonstrate time management skills to effectively manage the audits, consumer complaints, direct-action cases, reporting, and special projects
Assist when called upon to resolve complex technical questions, problems and/or complaints; establish and maintain rapport with field personnel, intra-departments, management, vendors, and agents
Maintain all company matters/issues confidentially
Collaborate with cross-functional team to achieve business results
Team oriented behavior, including the desire and ability to build strong working relationships and positive work environment
Receptive to feedback and willing to learn
Required education, work experience, licenses & certifications
Bachelor`s degree or equivalent experience.
Minimum 10 successful years of experience as a casualty, litigation, and/or property examiner who is proficient in coverage and liability analysis, compliance matters, litigation management, general law, and damages
A minimum of 2 years’ experience in handling regulatory data calls
