Sr Field QA Specialist Conduct onsite field inspections to review underwriting or claim files for accuracy and adherence to company and industry best practices and guidelines. Take the lead on partnering with the training department for identified training initiatives, identify and report on trends and feedback opportunities, and drive operational improvements through demonstrated leadership and strategic thinking skills.
Essential Functions:
Perform onsite field inspections in alignment with the established quality assurance review process; efficiently manage inspection schedule to ensure timely completion of associated desk-based reviews. Review claims or underwriting files for completeness and accuracy; verify that claims or underwriting documentation and decisions align with company guidelines, best practices and applicable state regulations. Accurately enter file review results into quality assurance software and provide clear and concise feedback for improvement to claims or underwriting staff. Apply an advanced understanding of P&C products, coverages, contracts, guidelines, and best practices to ensure accurate and effective quality assurance processes, support quality assurance strategies, and mentor team members. Lead and complete slant reviews on designated claims or underwriting topics as assigned; prepare comprehensive reports summarizing findings, insights, and actionable recommendations. Lead and facilitate process improvement and calibration sessions by driving discussion to identify any systemic issues and strategies for process optimization to ensure accuracy and alignment on internal quality assurance processes and scoring. Facilitate mentoring and training efforts for quality assurance-related inquiries and initiatives by ensuring alignment with training plans and objectives. Partner with leadership and training teams to refine claims or underwriting new hire and lifecycle training programs, leveraging advanced quality assurance knowledge to ensure alignment with adherence standards and regulations. Monitor and analyze quality performance indicators and metrics; translate findings into actionable insights for leadership; develop and deliver comprehensive reports and presentations on quality assurance trends. Serve as a primary representative on claims and underwriting cross-functional workgroups and strategic projects by providing guidance on quality standards, adherence requirements, and process integrity. Conduct multi-line quality assurance reviews to enhance cross-functional integration and operational scalability.
Qualifications/Know-How:
College degree or equivalent plus seven years' of relevant experience required. Multi-line claims or underwriting experience preferred. AINS, AIC, API, or AU designation preferred. Analytical, problem solving, decision-making and organizational skills required. Must keep current with claims or underwriting technologies/systems. Must keep up-to-date regarding legislation, statutes, rules/regulations, and case law for all eight states. A valid driver's license and satisfactory Motor Vehicle Records are required. Extensive travel (up to 75%) is required (including overnight) and must be able to work under all kinds of weather conditions. Oral and written communication skills as appropriate to this position. Ability to read, write and speak the English language. Training skills, attention to detail and the ability to meet target dates is also required. Ability to assist in multiple quality assurance areas or developing toward working with multiple insurance lines. Must be able to climb onto ladders, roofs, and other structures to inspect damage and lift a minimum of 75 pounds. Must obtain Haag Certification within one year of employment.
