Core QI Specialist II

In this role, you will review and analyze moderately complex Property Line of Business Files (Complex Property File) to determine alignment with claims handling standards (50-75% of time), in addition to providing less experienced/ new hire team members with training, coaching, and mentoring to expedite QIRP time to proficiency. Additionally, you will assist and participate in internal and external calibration, analysis of results and insights, development of QI reporting, and presentation of findings. The selected person will also participate in and/or facilitate smaller size operational events and provide support for implementation of improvements.

Responsibilities:

• Under limited direction, conducts virtual and on-site quality and/or performance audits of claims files, to include re-inspection of damages if appropriate on less complex claims.
• Analyzes all aspects of claims from notification to claims closure.
• Determine alignment with claims handling standards, policies and procedures as determined by calibration.
• Under limited direction, analyzes results and develops the necessary detail from audits conducted to assist the QI team in identifying the trends from an audit which, if corrected, would drive improvement.
• Under limited direction, assists in the preparation and leads presentation of results, conclusions and delivery of insights to field leadership on less complex claims.
• Assists with driving continuous improvements by providing feedback on audit process and tool changes that will result in a better product being delivered to the line of business.
• Under some direction, assist with the onboarding and coaching of new QI Specialists to improve team performance and reduce time to proficiency.
• Collaborate with other Core QI Specialists to capture leading practices and consistency.
• Act as the subject matter expert for the LOB in areas of project initiatives or existing programs.
• Performs other duties as assigned.