Senior Specialty Claims QA & Compliance Strategist

Westfield Insurance; Westfield Center (OH); Vor Ort; USD 85.000 - 120.000; Vollzeit

Zusammenfassung

Westfield Insurance is seeking a detail-oriented Senior Specialist to lead Specialty Claims Quality Assurance and Compliance. You will support claims governance, QA oversight, licensing compliance, and regulatory reporting, reporting to the VP, Specialty Claims Compliance.

You will analyze complex claim activity, identify trends and control gaps, and develop targeted training and actionable QA reports for Claims leadership, while ensuring adherence to internal standards and industry best

Qualifikationen

• Seven or more years of experience in Specialty insurance claims handling, quality assurance, compliance, or a related role.
• Strong knowledge of Cyber, Financial Institutions, Management Liability, Professional Lines, and applicable state and federal insurance regulations.
• Demonstrated experience reviewing complex claims and identifying quality, compliance, or control issues.
• Ability to analyze claim data and QA results to identify patterns, trends, and areas of risk.
• Strong attention to detail and sound judgment when evaluating claim handling decisions.
• Clear written and verbal communication skills, with the ability to provide constructive feedback and partner effectively with claim professionals and leadership.
• Professional insurance or compliance designations preferred.
• Ability and willingness to travel as needed.

Aufgaben

• Provide quality assurance and compliance support to Specialty Claims operations, including QA oversight and governance.
• Evaluate claim handling practices in high-risk and complex claim areas to identify trends, control gaps, and risks.
• Provide QA oversight for AI-enabled functionality used in claims, including reviewing outputs and governance controls.
• Collaborate with Claims leadership, Compliance, and Operations to address QA findings and improvements.
• Develop and deliver targeted training and guidance based on QA findings.
• Prepare clear, actionable QA reports summarizing findings, trends, and recommendations for Claims leadership.
• Monitor regulatory developments and industry trends affecting Specialty claims and update QA focus areas.
• Ensure licensing compliance tracking and documentation for internal staff.
• Monitor reinsurance and large loss reporting processes for timely reporting.

Kenntnisse

Specialty claims

Quality assurance

Regulatory compliance

Data analysis

Attention to detail

Written and verbal communication

Ausbildung

Professional insurance or compliance designation preferred

Tools

Guidewire ClaimCenter

Jobbeschreibung

Westfield Insurance is seeking a detail-oriented Senior Specialist to lead Specialty Claims Quality Assurance and Compliance. You will support claims governance, QA oversight, licensing compliance, and regulatory reporting, reporting to the VP, Specialty Claims Compliance.

You will analyze complex claim activity, identify trends and control gaps, and develop targeted training and actionable QA reports for Claims leadership, while ensuring adherence to internal standards and industry best