Senior Quality Improvement Specialist Claims Audit, Casualty

Company

Farm Family specializes in farm and ranch protection with a wide range of products including flexible farm packages business owner policies commercial package workers compensation commercial auto and select personal auto coverage. Farm Family is a leader in serving the Northeast and Mid-Atlantic markets and is pursuing growth across the U.S. The Farm Family entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.

Job Description

Job Profile: General Claims Professional 04P

Business Title(s): Senior Quality Improvement Specialist

Employment Type: Full-Time

FLSA Status: Exempt

Location: In Office - Any employee in any Clearbrook office can apply for this opportunity and stay in their current location.

We are looking for a highly effective Senior Quality Improvement Specialistto join our teamand work from our Omaha office. Alternatively we can fill this position in our Albany Chicago Los Angeles New York City or Richmond (VA) Senior Quality Improvement Specialist conducts data-driven quality claim audits of Handlers claims files in order toevaluate claims handling and outcomes against enterprise standards consistent processes governance and level of quality. The Senior Quality Improvement Specialist will provide feedback to the claims management team and recommend steps necessary to improve claims quality and outcomes which may include process improvements training or performance management.

This is a 100%in-office position. Candidates must be able to work on-site at a designated company office during standard business hours.

Essential Responsibilities:

• Under technical supervision and working within significant limits and authority conduct and document data-driven claim audits in the designated audit system within established timelines having a direct impact on department results.
• Evaluate claim files for adherence to enterprise standards and gaps between actual and optimal claims outcomes including but not limited to the areas of coverage analysis liability estimates accurate and timely reserving documentation and compliance with internal standards regulatory requirements and quality expectations.
• Analyze audit results and perform focused audits on specific trends as needed to identify gaps and opportunities for improvement.
• Translate audit findings into training process improvements and performance actions to claims staff and leadership.
• Escalate critical findings and provide immediate feedback to leadership when urgent action is needed on a claim.
• Participate in internal calibration activities within the Quality team to ensure scoring consistency.
• Partner with leadership to support training initiatives and process improvements.
• Consistently demonstrate exceptional customer service and appropriate technical expertise maturity and a professional commitment to excellence.
• Having an appreciation and passion for data analysis process improvement and training that elevates strong claim management throughout the department.

Required Qualifications:

• A broad theoretical knowledge of general liability claims as well as an exceptional customer service focus typically obtained through:
  • Minimum of two years of direct auto bodily injury liability or PIP handling experience with emphasis on complex highseverity commercial losses coverage reserving litigation management and claim strategy expertise.
  • Bachelors degree from an accredited university required. Two or more insurance designations or four additional years of related experience adjudicating claims beyond the minimum experience required above may be substituted in lieu of a degree.
• Must have good business acumen (i.e. understand how an insurance company works and makes money including how this role impacts both Farm Family and our customers ability to be profitable).
• Demonstrated ability to translate Quality Audit findings into measurable claim quality improvements operational changes training priorities and performance management actions
• Experience using structured feedback loops to claims management and claim handlers to ensure Quality Audit findings result in timely corrective action and sustained improvement.
• Excellent written and verbal communication skills including the ability to prepare clear summaries findings reports and presentations
• A strong focus on execution in getting things done right. Proven ability to consistently produce and deliver expected results to all stakeholders by:
  • Finding a way to achieve success through adversity.
  • Being solution (not problem) focused
  • Thinking with a global mindset first.

• Successful traits (flexibility ability to thrive in change being resourceful on your own) necessary to work in a fast paced environment that is evolving constantly.
• Must work independently and demonstrate the ability to exercise sound judgment. This role primarily faces problems and issues that generalized and typically not complex but require an understanding of a broader set of issues.
• Exhibit natural and intellectual curiosity. Consistently considers all options and is not governed by conventional thinking.
• Proficient in MS Office Suite and other business-related software.
• The ability to read and write English fluently is required.
• Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.

Preferred Qualifications:

• Experience working with Guidewire and Athenium auditing platforms and CCC
• Experience developing and presenting training materials based on Quality Audit results claim handling trends system utilization gaps and identified performance opportunities.

About Working in Claims at Farm Family

• Farm Family does not treat our claims or our claims professionals as a commodity. The work we offer is challenging diverse and impactful.
• Our Adjusters and Managers are empowered to exercise their independent discretion and within broad limits and authority be creative in developing solutions and treat each case as the unique situation it is.
• We have a very flat organizational structure enabling our employees have more interaction with our senior management team especially when it relates to reviewing large losses.
• Our entire claims team works in a collaborative nature to expeditiously resolve claims. We offer a work environment that inspires innovation and is open to employee suggestions. We even offer rewards for creative and innovative ideas.
• We believe in building an inclusive and diverse team and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply.

PLEASE NOTE:

Applicants must be legally authorized to work in the United States. At this time we are not able to sponsor or assume sponsorship of employment visas.

If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us please contact our Benefits Department at .

Benefits and Compensation

We offer a competitive compensation package performance-based incentives and a comprehensive benefits programincluding health dental vision 401(k) with company match paid time off and professional development opportunities.

Core Values

At Clearbrook our Core Values are Integrity Collaboration Pursuit of Excellence and Forward Thinking. These values reflect who we are today and who we aspire to be - guiding how we work how we lead and how we succeed.

Required Experience:

Senior IC