Head of Claims Quality Assurance

AmTrust Financial; New York (NY); Remote; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a Head of Claims Quality Assurance to enhance the quality and accuracy of claims processing. This pivotal role involves developing QA standards, conducting audits, and implementing training programs to improve operational efficiency and compliance. The ideal candidate will possess strong analytical and leadership skills, with a focus on driving best practices in claims handling. Join a forward-thinking company dedicated to fostering a diverse and inclusive culture, where your contributions will have a significant impact on the organization’s success.

Benefits

Medical & Dental Plans

Life Insurance

401k Savings Plans

Paid Time Off

Flexible Spending Accounts

Qualifications

• Thorough understanding of insurance laws and principles.
• Ability to work independently with minimal supervision.

Responsibilities

• Oversee quality assurance processes for claims operations.
• Conduct audits and ensure compliance with standards.
• Develop training programs for claims staff.

Skills

Analytical Skills

Leadership Skills

Effective Communication

Human Relations Skills

Education

College Degree

10 Years Equivalent Experience

Job description

Head of Claims Quality Assurance

Job Locations

US

Requisition ID

JR1003453

Category

Claims - Specialty Lines

Position Type

Regular Full-Time

Overview

Objective

To oversee, enhance, and ensure the quality and accuracy of claims processing, contributing to operational efficiency, compliance, and customer satisfaction.

Scope of Work

The Claims QA Leader will be responsible for developing and implementing quality assurance processes for AmTrust's internal and TPA claims operations. They will oversee audits, analyze trends, and collaborate with teams to improve accuracy, compliance, and efficiency in claims processing.

Responsibilities

Quality Assurance Oversight

Develop and implement quality assurance (QA) standards and best practices for claims handling alongside our claim leaders.
• Monitor and evaluate the accuracy of claims adjudication, identifying discrepancies and leakage.

Auditing and Compliance

• Conduct routine and ad-hoc audits to ensure compliance with regulatory and organizational standards.
• Report audit findings and prepare actionable reports for leadership.
• Create calibration process to ensure standards are equally measured.

Training and Development

• Create training programs and materials to address performance opportunities identified through audit.
• Mentor and coach claims staff on quality assurance protocols and best practices.
• Develop training to address and cut down on leakage.

Performance Monitoring

• Establish and track key performance indicators (KPIs) for claims quality.
• Collaborate with teams to set realistic goals and track progress over time.

Process Improvement

• Analyze claims data to identify trends and areas for improvement.
• Work with cross-functional teams to recommend and implement process enhancements.

Stakeholder Communication

• Act as the primary liaison between QA and claims department teams to resolve issues.
• Present QA findings and improvement initiatives to leadership and stakeholders.
• Ability to drive best in class claims handling results through collaboration with department heads.

Goals and Benchmarks

Short-Term Goals (First 3-6 Months)

• Develop and implement a audit framework for claims handling.

• Conduct baseline audits to establish performance metrics.

• Train claims staff on QA processes and compliance requirements.

Medium-Term Goals (6-12 Months)

• Achieve a claims audit score of 90% or higher.

• Identify and address the recurring quality issues in claims handling.

• Reduce leakage rate by at least 5% through targeted training and process improvements.

Long-Term Goals (12+ Months)

• Maintain a consistent claims accuracy rate of 90% or higher.

• Achieve a leakage rate of less than 3%.

• Implement advanced analytics tools for QA monitoring.

Deliverables

• Quarterly QA performance reports, including trends, benchmarks, and actionable recommendations.

• Comprehensive training materials for claims teams.

• Updated QA protocols and workflows.

• Action plans to address recurring claims processing errors.

Performance Evaluation

Success in this role will be measured by:

• Achievement of defined accuracy and compliance benchmarks.

• Reduction in claims leakage.

• Positive feedback from internal teams and stakeholders.

• Consistent delivery of actionable insights and process improvements.

Qualifications

• Thorough understanding of laws, principles of coverage, liability and insurance industry in general.
• Analytical and human relations skills are critical.
• Leadership skills; ability to plan, organize, delegate and develop staff.
• Effective communication skills; ability to obtain and deliver information to others orally and in written form.
• Ability to work with little supervision and direction.
• Ability to operate business technology.
• College degree or 10 years equivalent experience and skills required.

#LI-REMOTE

#AmTrust

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

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