Overview
Quality Assurance Specialist Jobs in Mayaguez, PR at LabChemS Corp.
Position Summary:
The Quality Assurance Manager role is to identify resource needs for the QA Team and ensure that all team members have received sufficient training on processes and procedures as they relate to the current event. The role is also responsible for ensuring that claim files meet the quality standards set by claims operations and the client. This role provides feedback and direction to field and desk adjusters as needed to ensure file quality is consistent with approved guidelines. This role can/will provide some training to adjusters based on review of submitted claim files.
Primary Responsibilities:
Create and document QA File Examiner workflows and Procedures.
Coordinate Examiner Schedules and Time-off requests to ensure appropriate coverage is maintained.
Maintain a list of qualified Examiners that can be activated and trained if necessary.
Train New File Examiners on company Specific Responsibilities
Train Examiners on the company Invoicing System.
Compile Examiner production reports and approve timecards.
Monitor File Examiners production logs to ensure that that the majority of their time is spent reviewing files.
Monitor review queue volume, assign claims to file examiners.
Audit File Examiners work to ensure that the Examiner is reviewing claim in accordance with the guidelines of that specific client.
Conduct Examiner Performance reviews annually and provide written review to directors.
Review claim files for completeness, accuracy, and timeliness. This includes:
An assessment of claim files to ensure files contain proper scene documentation and/or other necessary documents.
Coverage review to ensure coverage was properly applied when the adjuster made his / her payment recommendations
Audit and review estimates for accuracy and/or estimatic issues. This includes reviewing estimates to ensure compliance with carrier client standards and estimating guidelines.
Collaborate to correct incomplete files or adjuster errors.
Submit completed claim files to the carrier clients through XactAnalysis or other means.
Review, and when possible correct, client rejected claim files.
Monitor claims that were returned to the adjuster for corrections to ensure the corrections are made timely and the claim file is returned within the SLO required time frame.
Communicate adjuster training issues to Claims Management.
Make certain that we are providing complete and solid claim settlements, legal reviews, and investigations when necessary.
Ensure that all claims meet or exceed SLO’s (Service level Objectives)
Must be familiar with a field inspection concepts, practices, and procedures.
Must be familiar with Claim settlement practices as prescribed within the states that the examiner is supervising/reviewing claims.
Must have all of the current and appropriate adjuster licensing in the states that the examiner is supervising/reviewing claims.
Provide clear supervisory direction to field adjusters.
Will make all necessary recommendations for resolution of the claims
Will have contact with:
Client supervisors and adjusters
Agents
Claimants
Policyholders.
Must have a working knowledge of Xactimate /Sketch to assist field adjusters with
General Xactimate and Sketch questions
Xactimate installations
Low level technical support issues
Must have a working knowledge of XactAnalysis to assist field adjusters with
Workflow in preparing files to be uploaded through Xactnet for Management review.
Low level technical support issues
Must have a working knowledge of ClaimAssist to assist field adjusters with
Workflow in preparing files to be uploaded for Management review.
Low level technical support issues
Ensure adjusters working in assigned operations are meeting client and company requirements.
Answer and provide support for adjusters in assigned operations.
Keep updated documentation and supporting documentation regarding (For each Client):
Claim Adjuster Guidelines
Claim File Guidelines
Coverage Guidelines by State or Region separately for each client
File Examiner guidelines and Training aids
Manage and document file examiner workflows and procedures for assigned accounts.
Collaborate with Management, Training, and Recruitment to design and implement training and certifications for assigned accounts.
Collaborate with Management, Training, and Recruitment to identify and connect with prospective adjusters anticipated for assigned accounts
Collaborate with Management and Claims Administration to develop and implement workflows to received, assign and report on claims assigned by account.
Assist with development of methods to measure and track quality assurance.
Manages and provides direction for assigned adjusters, including regular coaching and feedback for improvement.
Inform and update adjusters on procedural and organizational changes within the client or company home office.
Troubleshoot and resolve routine adjuster and policyholder issues.
Assist with targeted adjuster recruiting, hiring, interviewing assignment and other human resources functions.
Core Competencies:
Ability to comprehend complex claims handling procedures.
Ability to work well with others and to demonstrate an excellent quality of work with little or no supervision required.
Must be highly organized and possess excellent verbal communication, follow up and documentation skills.
Strong customer service focus and customer relations skills.
Strong teamwork skills.
Proven record to develop and motivate people to succeed.
Ability to strategically think through new processes and create a vision others will follow.
Highly proficient in Microsoft Outlook including calendars, meeting/event scheduling, tasks, and folders
Highly proficient in Microsoft Word, Excel, PowerPoint, and Adobe Acrobat.
Must be willing to work non-traditional business hours and weekends when required during peak catastrophe situations.
Experience Required:
Minimum of 1 year of experience in a claims management position
Experience in creating and interpreting productivity reports
Technical claim experience
Experience with Xactimate and XactAnalysis.
Strong online experience
Experience of working in a client support role
Experience in project management
Excellent written and spoken communication skills
Preferred Educational Background:
University degree or equivalent experience
AIC and/or ANFI Designation or working towards designations
Soft Skills:
Ability to communicate well with people at all levels and backgrounds
Work well with other team members
Sense of urgency when needed
Exemplary people skills
Analyze problems/issues and present creative solutions
Knack for getting the job done
Identification of opportunities to help leadership delegate responsibilities Customer service minded
Problem solving skills – Solutions oriented
Results driven
Attention to detail
Proactive and take initiative
Team player
Self-motivated
Hands on approach
Flexible approach
Ability to working towards strict deadlines
Benefits:
Eligibility to participate in Comprehensive Benefits Package: Medical, Dental and Vision, Paid Time Off and Paid Holidays, in accordance with Company policy.
Job Type: Full-time
Salary: $67,000.00 per year
Benefits:
Dental insurance
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid time off
Referral program
Vision insurance
Allcat Claims Service
Allcat Claims Service, LP is a total solution provider for all of your insurance claims needs. We can handle all aspects of your claims process, including initial calls received during normal business hours; as well as weekends, after hours and emergency call centers. We can also handle the estimating, closing and issuing of checks for the claim as well as issuing depreciation holdback and indemnity checks. With our real-time electronic reporting and tracking of claims, you will always be able to have the most updated information for your organization to make the most informed decisions. We have the knowledge and the team in place to make your claims department the best that it can be.
Title: Quality Assurance Specialist
Company: LabChemS Corp.
Location: Mayaguez, PR
