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Claims Quality Assurance Specialist

Location: Tampa, FL
Position Number: 00184
# of openings: 1

Description

POSITION SUMMARY:  This position is responsible for supporting Quality Assurance for the Non Catastrophe & Catastrophe Claims Operations by auditing the claims processes including coverage analysis, investigation, valuation, reserving, and accurate disposition of claims.  This position is also responsible for developing and delivering claims training as necessary, assisting in business process improvement and preparing proactive claims solutions that maximize efficiencies. This position mandates successful completion of all 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 and ethics policies.
  • Assist the Claims Quality Assurance Program in developing and implementing quality improvement strategies.
  • Conduct claim file audit reviews and other quality assurance projects as needed.
  • Provide feedback on claim quality audit results and make recommendations for improvements.
  • Support the Catastrophe Claim Reinspection Programs, which involves physical re-inspections of damaged properties.
  • Determine, monitor and analyze measurements; conduct trending analysis; identify leakage; and prepare objective reports.
  • Create, present and perform calibration Quality Assurance training sessions and assist Claims employees to increase knowledge and skills necessary to achieve improved results. 
  • Assist the Claims Organization by conducting field Quality Assurance training at remote locations as needed.
  • Conduct field re-inspections throughout the state of Florida.
  • Participate in co-inspections with staff and external business partners as needed.
  • Interact face to face 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.
  • Provide claims-related information to the Claims Quality Assurance management.
  • 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.
  • 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.
  • Create, maintain, and update quality assurance training materials as necessary for use in quality assurance training sessions.
  • Integrate and deliver property claims training programs in the context of Quality Assurance calibration exercises (e.g., policy, estimatics, systems, workflows, statutes).
  • Participate in Catastrophe responses, as needed. 
  • Position may involve serving in the Team Lead role for various claims units when needed.

Required Knowledge, skills, and abilities:

  • Intermediate proficiency in Microsoft Office Word, Access, Excel, Outlook, and Internet navigation
  • Strong ability to effectively communicate verbally and in writing, to include presentation skills.
  • Knowledge of Quality Assurance and training principles.
  • Ability to plan, prioritize workload, organize and coordinate multiple tasks and projects.
  • Ability to use problem-solving and analytical techniques.
  • Ability to translate technical data into user-friendly documentation, training materials, process flows, etc. Knowledge and experience in construction; repair methodology, understanding of building codes, and ability to converse effectively with vendors.
  • Teaching/training skills.
  • Ability to conduct field inspections of damaged property, including roof inspections.
  • Experience with Xactimate estimating platform.

REQUIRED EDUCATION AND EXPERIENCE:

  • Associate’s degree in field with skills transferrable to insurance or equivalent of two years in college education and work experience relevant to position.
  • 4 or more years of property insurance claims experience.
  • Experience with file audits.
  • Experience with hands-on training development and presentation.
  • Must possess a valid, active and appropriate Florida adjuster license by first day 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.
  • 6 or more years of field property and casualty insurance claims experience.
  • 2 or more years experience conducting property claim audits.
  • Advanced proficiency in Microsoft Office Word, Access, Excel, Outlook, and internet navigation.
  • Active Florida Adjuster license (620 or 644).
  • Experience with Citizens’ CTS or equivalent electronic claims system.
  • Comprehensive knowledge of property estimating programs (such as Xactimate and Xactanalysis).
  • Experience presenting to large groups (30 or more attendees).
  • Insurance Designations (AIC, CPCU, CLU, ChFC, ARM, INS).

PHYSICAL REQUIREMENTS: 

This position requires the ability to sit or stand for long periods of time, hear and converse over the telephone, to speak to large groups both with and without microphone and to key frequently on a computer (2 or more hours per day).  Position also requires ability to inspect damaged property; climb a ladder and ability to inspect roofs, inspect homes as needed, including attics, crawl spaces, navigating through debris, and activities associated with measuring and taking photos.  Position requires overnight travel.

 





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