Sr. Quality Assurance Advocate/Specialist

Published
May 12, 2021
Location
Nationwide, Remote
Category
Job Type

Description

Act as a primary adjuster/oversight for Reinsurance claims. Handle a caseload of approximately 150 medium to high complexity reinsurance claims involving oversight for all lines of business, including Workers’ Compensation. Timely follow up with Member Companies and reports for the Client. Maintain appropriate reserves and may direct Member Company adjusters’ activities for certain claims. All file handling must be within state statutes, Client Account Handling Instructions and NARS Best Practices.

Assist Quality Assurance team with file audits, employee training, process improvement, and other miscellaneous projects as requested.  Define and maintain Best Practices, refining them as new case law, regulations or innovate approaches come to light.

Essential Duties and Responsibilities:

 Claim Handling Oversight:

  • Identify, analyze, and confirm coverage.
  • Acknowledge receipt of claim to Member Company and Client within 4 hours of receipt.
  • Contact appropriate parties and other involved carriers to place them on notice of a claim.
  • Set appropriate reserves according to information received from Member Company.
  • Set diary reminders for appropriate follow up with Member Company for report, investigation, and litigation updates, reserve changes, and any other updates as presented.
  • Update claim file notes and reserves appropriately.
  • Complete coverage letters and Pre-Trial Litigation reports for the client as needed.
  • Communicate with Member Company and Clients as appropriate for significant changes and closures.

 Quality Assurance:

  • Assist Quality Assurance team when requested with:
  • Claim file audits.
  • Regulatory Agency and Service Complaints investigation and response.
  • Employee training.
  • Process Improvement.
  • Additional projects as requested.

Education / Licensing:

  • High School Diploma or equivalent required, 2-year degree or higher preferred.
  • 2 to 5 years claim handling experience.
  • Must possess a current Florida Adjusters license and required jurisdictional licensing.

 Technical Skills:

  • Must be genial and have a high level of interpersonal skills to handle complex, sensitive, and confidential matters with patience, objectivity, and diplomacy.
  • Must possess strong customer service skills along with critical analysis of trending, problem solving analysis and correction planning skills.
  • Previous negotiation and litigation skills preferred, but not necessary.
  • Must be able to work independently and possess excellent written and verbal communication skills.
  • Advanced knowledge of a variety of computer software applications in word processing, spreadsheets, database, and presentation software. (Microsoft Office platform.)

 Abilities:

  • Ability to travel when needed.
  • Requires long periods of sitting.
  • If you live within 25 miles of an office, you will be required to commute and work out of that office.
  • Requires working indoors in environmentally controlled conditions.
  • Requires lifting of files and boxes up to approximately 20 pounds.
    • Repeated use of keyboard, mouse, and exposure to computer screen.
Apply
Drop files here browse files ...

Related Jobs

Large Loss Claims Consultant   Nationwide, Remote new
June 16, 2021
UI/UX Designer   Altamonte Springs, FL
May 4, 2021
Recruiting Specialist   Altamonte Springs, Florida
May 4, 2021
Outbound Customer Care Specialist   Nationwide, Remote
May 4, 2021
Are you sure you want to delete this file?
/