Worker's Compensation Quality Assurance ManagerImperial staffing and associates • Pasadena, Texas, United States
Worker's Compensation Quality Assurance Manager
Imperial staffing and associates
- Pasadena, Texas, United States
- Pasadena, Texas, United States
Über
Duties and Responsibilities
Heavy involvement in drafting quality assurance policies and procedures and ability to interpret and implement quality assurance standards based upon review of data
Conduct regular self-audits of WC claim operations results, processes and workflows to measure compliance and effectiveness
Document and track claim metrics of our TPA by office/region and providing senior leadership and all claims operation staff with quarterly reports detailing results and action items
Conduct audits of our TPA’s and internal staff to monitor compliance with policies and best practices
Ability to break down problem into manageable components
Can recognize symptoms that indicate problems and develop and implement solutions with minimal oversight
Ability to work closely with TPA operational and account management personnel
Must be an effective communicator who can adjust their message and approach to successfully influence up, down and across organizational boundaries
Evaluate adequacy of quality assurance standards, make changes where warranted
Devise auditing procedures and directions for recording and reporting quality data
Review the implementation and efficiency of quality assurance process
Investigate service complaints and non-conformance issues with TPA and internal staff
Track, measure, and benchmark all line of business metrics
Analyze data to identify areas for improvement in the quality system
Develop, recommend, and monitor corrective and preventive actions
Prepare reports to communicate outcomes of quality activities
Identify training needs of both our TPA’s and internal staff and organize training interventions to meet quality standards
Coordinate and support all line of business audits that will include TPA’s, vendors, and internal audits
Evaluate audit findings and implement appropriate corrective actions
Qualifications, Knowledge and Experience
To perform this job successfully, an individual must possess advanced technical WC claims knowledge, extensive claims handling and operational claims experience working for an insurance carrier. The successful candidate must have excellent communication skills and have experience making presentations, preparing reports, and implementing training for stakeholders in all levels of a claims organization. In addition to strong analytical and time management skills, this individual should be able to work well independently and as part of a team to meet established deadlines and metrics. The successful candidate will have experience in claims auditing and developing quality assurance programs with extensive experience and positive track record on implementing solutions.
The requirements listed below are representative of the knowledge, skills and/or ability required.
Extensive knowledge of claims industry best practices, standards and regulations in multiple jurisdictions.
Ability to handle complex projects and assignments which involve analysis, implantation, and communication of findings to leadership and other stake holders
Attention to detail and impeccable time management skill required
Extensive insurance knowledge in Workers’ Compensation (multiple jurisdictions preferred)
Advanced Excel worksheet skills
Ability to travel to multiple locations across the county
Supervisory /leadership experience is required
Computer Experience with related claims and business software
10+ years prior claim experience to include 3+ years in a leadership role
All your information will be kept confidential according to EEO guidelines.
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Sprachkenntnisse
- English
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