Claims Quality Assurance Specialist Helena, MT

Claims Quality Assurance Specialist

 
Job ID: Job-1165       

location:       Helena, MT     
Jobtype:        Permanent      

Description:    Conducts claim reviews and audits for quality assurance and claims best practices. Reports results to Operations Team Leaders and Operations Support Claims Team Leader. Provides recommendations for education, training and mentoring of claims examiners. Conducts special claim reviews as requested by leadership and to investigate claims trends. Works with Claim Leads to prepare action plans for claims examiners to address technical development needs. Coordinates with Claim Leads to coach and mentor examiners. 

Recommends and provides education, training and mentoring related to claim management. Provides follow up to monitor progress and outcomes. Conducts large loss and catastrophic claim meetings to review, advise and develop plans of action, review reserve adequacy and to recommend resources needed to address key claim issues. Individual assignments including but not limited to reinsurance reporting, claims center training and vocational rehabilitation contract management. Review of forms, instructional memos, guidelines and other claim related publications and communications to ensure accuracy. 

Qualifications: 
Requires bachelor’s degree plus 8 years of workers’ compensation indemnity work experience; or 3 years as MSF CEIII; or High School or GED and 4 years of insurance experience in a workers’ compensation setting plus 8 years workers’ compensation indemnity work experience. Certifications relevant for claim professionals preferred. 

CORE COMPETENCIES: Customer Service, Initiative, Accountability POSITION COMPETENCIES: Concern for Quality, Job Knowledge, Decision Making 

You will not be handling Live Claims. They will need to make sure they are in Compliance. 


Email resume in Word to TheBigGameHunter@cisny.com. Please include the job code for the position with your resume. 

NO RELOCATION. NO VISA TRANSFERS. NO OVERSEAS RESUMES. NO 3RD PARTIES. 

To receive a complimentary subscription to my job search ezine, No B.S. Job Search Advice, go to www.JeffAltman.com to subscribe. 

Receive tweets from Twitter with job search tips and job listings – TheBigGameHuntr