Quality Analyst For Claims Process

Job Description

Role & responsibilities Liaise with clients and SMEs to design, implement, and conduct an effective QA process to identify trends and training opportunities. Strong experience of monitoring calls/chats/e-mails and end to end processed cases/claims as per defined sample plan. Perform Root Cause Analysis (RCA) and take corrective actions for defects identified during monitoring, report out any zero tolerance or negative CX or indemnity spend impacting claims to take necessary actions. Ability to drive monitoring improvement plan (MIP) for repeated errors or critical errors. Ability to analyze, compile and present data regarding QA metrics to all stakeholders. Maintain up-to-date understanding of claim handling procedures and regulatory requirements. Conduct regulatory research to support development of compliant claims handling practices. Deftness in identifying and making recommendations to improve our overall claims customer experience alongside aiding in refinement of standards of excellence, best practices, and training materials. Develop and monitoring process enhancements that support AirCover operations, promoting a culture of service excellence Support external claims audits for ensuring firm adherence to regulatory and statutory compliance requirements. Strong organizational and problem-solving skills with the ability to gather information, analyze critically and cut through complexities to arrive at workable solutions. Preferred candidate profile Bachelors degree or college diploma. Overall 2 -3 years of experience with at least 1-2 year in quality management/audit/SME support for Insurance claims (Back-office and Front Office operations) functions. Proficient in MS Office - Excel, PowerPoint and system-based audit tools. Experience in audit, risk management, regulatory compliance, processes and controls is preferred but not necessary. Ability to provide and receive feedback with effective conflict management skills. Customer centric and ability to drive process improvements. Team player and be able to operate under pressure and ambiguous situations.