AVP, Global Claims Quality Assurance

Title:

AVP, Global Claims Quality Assurance

Company:

Everest National Insurance Company

Job Category:

Claims

Job Description:

An exciting opportunity to join one of the fastest growing insurance companies in a truly global role where you can make a difference and have real influence!

Whilst Everest has a 40-year history of success, Everest Insurance is still relatively young and is experiencing significant continued growth resulting in exciting and challenging opportunities.

Everest has been a global leader in reinsurance with a broad footprint, deep client relationships, underwriting excellence, responsive service, and customized solutions. Our insurance arm draws upon impressive global resources and financial strength to tailor each policy to meet the individual needs of our customers.

Throughout our history, we have maintained our discipline and focus on creating long term value through underwriting excellence and strong Risk and Capital Management. We believe that our future is determined by the actions we take today, actions that go beyond business strategy and encompass the values important both to us and the communities in which we operate.

Role Purpose:

As a member of the Global Claims Quality Assurance program within Everest Insurance, the purpose of this role is to perform technical and operational claim audits, data analysis, training, reporting, audit system support, and other activities that will improve claim outcomes, avoidance of loss cost leakage, mitigate risk, and demonstrate quantifiable improvement.

Travel:

10-20%. May require two-week domestic or international travel over weekends.

Key Accountabilities:

What do we expect you to do?

On a Strategic Level

• Design support for and validation of QA function controls, process, capabilities, performance tracking
• Leadership of Quality Review and Focus Reviews. May be asked to perform reviews
• Re-Review of Supervisory Reviews to ensure supervisors are accurately reviewing files
• Performance MI & recommendations to continually enhance and improve QA
• Best Practice Subject Matter Expertise
• TeamThink QA System Development UAT, and Support
• Perform Operational Risk and Controls Reviews
• Delivery of Audit Findings
• Improvement Plan monitoring

Operational expectations

• Audit Leader for Claim Best Practice-Leakage, and Controls based (operational) Audits. May be asked to participate on reviews as an auditor, and or conduct Supervisory Reviews
• Ensure accuracy of all audit findings, information, and documents
• Dissect complex data sets, identifying “root cause” of issues/trends related to non-compliance. Develop audit plans and scope by reviewing available information and conducting research and analysis
• Plan audits and write clear and concise reports that give senior executives key information. Reports must be balanced, constructive and help management grasp the key issues in a way that will encourage them to be proactive
• Develop and monitor measurable improvement plans and effectively communicate so that management, QA team, and stakeholders are all working together
• Comply with all applicable standards, policies, guidelines, and procedures.
• Ensure BPs and standards are effectively designed, in place, and operating as intended
• Support of business cases for the implementation of technology solutions
• Anticipated overnight travel is 10% but could reach 20%. Will likely be in peaks and may include international travel 2 weeks at a time
• Must be fluent in English, with fluency in second language preferred
• Flexibility to work within global time zones, including travel, meetings while working remotely, etc.
• Execution of yearly business goals
• Timely and high-quality delivery of Audits

People expectations

• Highly collaborative and communicative stakeholder engagement with Regional Claim teams and stakeholders
• Deliver audit objectives by leading teams who are not direct reports. This may include Everest guest auditors, colleagues, or external vendors
• Evaluation of staff training needs and coaching
• Align, empower, and influence others through ideas, encouragement, and insight
• In future, position may require managing direct reports

What skills do we expect you to have?

Skills & Abilities:

• 10 or more years of commercial technical claim adjusting experience with specialization in at least one Technical Line
• Experienced in leading and managing claims technical quality audits
• Deep knowledge of Claims processes and organizations; will preferably have a background in claim management
• Ability to learn and apply claim best practice standards to claim files.
• Ability to learn and navigate Everest and TPA claim systems effectively
• Strategic thinker, innovative and solution-oriented
• Exceptional oral and written communication, with the ability to provide concise executive summaries and audit reports to senior management
• Highly collaborative and able to work effectively across the organization as well as with external stakeholders
• Ability to adapt and embrace change, solutions driven
• Ability to perform root cause analysis of complex claim handling and controls issues to identify appropriate improvement solutions
• Ability to analyze training needs and situations to determine if performance can be improved through training
• Ability to work independently on assignments of moderate to high complexity
• Courage to face difficult issues, and to provide direct and actionable feedback despite dissent or political risk
• Strong interpersonal skills and demonstrates respect for the opinions of others

Professional qualifications and experience:

• Experience in technical insurance claims auditing required, preferably as a QA Manager
• Demonstrable extensive experience in Claims Quality Assurance in a P&C insurance environment. International experience is preferred
• A degree educated professional, preferred
• Demonstrative experience with software applications, including multiple claim systems, QA web-based auditing tool, Microsoft Office, with heavy focus on MS Excel spreadsheets, charts, and pivot tables

Competencies:

As a leader within Claims must champion the Everest Insurance Culture:

• Collaboration: Open and transparent communication with customers and colleagues
• Diversity, Equity, and Inclusion: Through a welcoming and open environment that values all individuals
• Thoughtful Assumption of Risk: Supporting the Everest goal of carefully writing profitable business by ensuring data quality, prompt and accurate feedback to Underwriters, and operational control throughout the enterprise
• Execution: Delivering outstanding support to the organization through strong day-to-day business operations, effective project management, and careful oversight of vendors
• Humility: Caring and respectful approach to service colleagues, customers, and the community
• Leadership: By example, every day

 

The Everest Core Values are the foundation upon which we (a) conduct our work, and (b) conduct ourselves both internally with our colleagues, and externally with clients/customers. The Company's success and that of our employees begins with these values. All employees are expected to support and exhibit these values in their interactions with others and through their day-to-day responsibilities.

Our Culture 

At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors. Click here to learn more about our culture. 

  

• Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Diversity, Equity and Inclusion.  
• Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together.  

  

All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve.  

Type:

Regular

Time Type:

Full time

Primary Location:

Warren, NJ

Additional Locations:

Philadelphia, PA
Stamford, CT