Job SummaryUnder the general direction of the Quality Control Manager (QCM), the Quality Control Assistant (QCA) will be responsible for assisting with two areas of focus: quality control processes and identifying opportunities for and delivery of A-G training. The QCA will collaborate with the QCM to provide quality feedback to various internal departments and conduct external carrier audits to ensure quality and ongoing compliance with various guidelines and programs. Through gap analysis of quality data, this role will also partner with the Training and Development Manager (TDM) to identify trends that lend themselves to additional training opportunities. The QCA will also assist with the development of training materials, job aids and delivery of the content as necessary.Essential Duties & FunctionsReasonable accommodations may be made to enable individuals to perform the essential functions.Quality Control (75%):
- Assist with conducting Internal Quality Reviews (IQRs) for all claim examiners
- Prepare and submit documentation required for carrier audits
- Respond to audit reports, initiate follow-up actions and ensure appropriate actions are taken.
- Provide feedback to claims management pertaining to trends identified in the IQR process.
- Ensure compliance with company policies, procedures and guidelines, as well as state and federal insurance regulations
- Recognize and properly address coverage issues, potential fraud, and subrogation
- Support ad-hoc projects as needed
- Refer cases as appropriate to supervisor
- Other duties as assigned
Training & Development (25%):
- Assist in evaluating trends in the quality control processes and incorporate identified gaps into the training strategies to mitigate recurrence.
- Assist TDM with delivery of intensive, on-site training for new claims examiners
- Assist in proficiency evaluations of new examiners.
- Collaborate cross-functionally to identify strategic implementation and deployment of new training materials to ensure quality control across the organization while complying with local or state regulations.
Job Skills
- Attention to detail
- Excellent verbal and written communication
- Prioritize tasks appropriately and maintain organization
- Advanced critical thinking and problem-solving skills
- Strong decision-making ability and sound judgement
- Build client relationships
- Self-starter and self-disciplined in accomplishing tasks
- Ability to work unsupervised
- Team Player
- Highly proficient in Microsoft Office (Excel, Word and Teams) and Adobe
Job QualificationsTo succeed in this role, an individual must be able to perform each essential duty effectively. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Required/Preferred Education and ExperienceRequired Education: Bachelor's Degree or Equivalent ExperienceRequired Experience: 1-3 years claim examiner experiencePreferred Licensure: Accident & Health Adjuster LicensePosition Type and Expected Hours of WorkThis is a full-time, hybrid position. Days and hours of work are Monday through Friday, 8:30 a.m. to 5 p.m. Presence in the office will be required during initial hire, carrier audit cycles and while facilitating delivery of training to A-G team members, and any additional agreed upon days. The schedule for this role can be contingent upon Supervisor and Human Resources approval. Some evening and weekend work may be required. TravelVery occasional travel may be required and would be discussed well in advance.