- Lead a team of Quality Assurance Representatives or Claims Quality & Subrogation Analysts
- Review claim files for accuracy and compliance with CA Department of Insurance Fair Claims Settlement Practices Regulations
- Manage communications with the Department of Insurance
- Assist claims examiners with coverage analysis
- Collaborate with analyst and QA Representative teams to maintain daily workflow
- Develop and implement quality assurance policies, procedures, and workflows
- Hire, train, mentor, and support QA Representatives and Claims Quality & Subrogation Analysts
- Provide file data for reviews and maintain the audit platform
- Direct and oversee file reviews and manage responses to CDI complaints
- Provide feedback on auditing accuracy and CDI response letters
- Make recommendations for training and improvement based on findings
- Manage monthly file audit calibrations and summarize results
- Review and analyze claim handling practices
- Review repair estimates for accuracy and adherence to industry/CFP guidelines and client requirements
- Compile estimate revision requests and coordinate with network contractors
- Create and maintain workbooks, questionnaires, processes, and training materials
- Lead projects including QA software and report implementation
Requirements
- Bachelor’s degree or equivalent preferred
- Strong knowledge of quality assurance and property claims
- Minimum of 5-10 years property insurance claims experience
- 2+ years of supervisory experience
- Strong organizational, file management, and time management skills
- Attention to detail; ability to prioritize and make strong decisions
- Excellent written and oral communication skills
- Adaptability and demonstrated ability to manage change
- Working experience with MS-Office is required
- Proficient in the Xactimate estimating program
- Certified in CEA and CA Fair Claims Settlement Practices Regulations
Core Competencies
Demonstrates expertise in quality assurance processes and property claims management, with a strong focus on compliance with CA Department of Insurance regulations. Proven ability to lead teams, develop training materials, and implement effective workflows to enhance operational efficiency.
Highest-signal resume keywords
- Quality Assurance Management
- Property Insurance Claims Experience
- Supervisory Experience
- Xactimate Estimating Program
- CA Fair Claims Settlement Practices Certification
ATS Optimization Keywords
Hard Skills
- Quality Assurance
- Claims Review
- File Management
- Coverage Analysis
- Audit Platform Maintenance
- Repair Estimate Review
- Workflow Development
- Data Analysis
- Training Development
- Project Management
Soft Skills
- Organizational Skills
- Time Management
- Attention to Detail
- Decision Making
- Adaptability
Certifications & Qualifications
- CEA Certification
- CA Fair Claims Settlement Practices Certification
Industry Keywords
- Claims Quality
- Subrogation
- Department of Insurance Compliance
- CFP Guidelines
- Audit Calibration
Tools & Technologies