AVP, Global Claims Quality Assurance
: Job Details :

Title:AVP, Global Claims Quality AssuranceCompany:Everest Insurance CompanyJob Category:ClaimsJob 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 LevelDesign support for and validation of QA function controls, process, capabilities, performance trackingLeadership of Quality Review and Focus Reviews. May be asked to perform reviewsRe-Review of Supervisory Reviews to ensure supervisors are accurately reviewing filesPerformance MI & recommendations to continually enhance and improve QABest Practice Subject Matter ExpertiseTeamThink QA System Development UAT, and SupportPerform Operational Risk and Controls ReviewsDelivery of Audit FindingsImprovement Plan monitoringOperational expectationsAudit 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 ReviewsEnsure accuracy of all audit findings, information, and documentsDissect 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 analysisPlan 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 proactiveDevelop and monitor measurable improvement plans and effectively communicate so that management, QA team, and stakeholders are all working togetherComply with all applicable standards, policies, guidelines, and procedures.Ensure BPs and standards are effectively designed, in place, and operating as intendedSupport of business cases for the implementation of technology solutionsAnticipated overnight travel is 10% but could reach 20%. Will likely be in peaks and may include international travel 2 weeks at a timeMust be fluent in English, with fluency in second language preferredFlexibility to work within global time zones, including travel, meetings while working remotely, etc.Execution of yearly business goalsTimely and high-quality delivery of AuditsPeople expectationsHighly collaborative and communicative stakeholder engagement with Regional Claim teams and stakeholdersDeliver audit objectives by leading teams who are not direct reports. This may include Everest guest auditors, colleagues, or external vendorsEvaluation of staff training needs and coachingAlign, empower, and influence others through ideas, encouragement, and insightIn future, position may require managing direct reportsWhat 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 LineExperienced in leading and managing claims technical quality auditsDeep knowledge of Claims processes and organizations; will preferably have a background in claim managementAbility to learn and apply claim best practice standards to claim files.Ability to learn and navigate Everest and TPA claim systems effectivelyStrategic thinker, innovative and solution-orientedExceptional oral and written communication, with the ability to provide concise executive summaries and audit reports to senior managementHighly collaborative and able to work effectively across the organization as well as with external stakeholdersAbility to adapt and embrace change, solutions drivenAbility to perform root cause analysis of complex claim handling and controls issues to identify appropriate improvement solutionsAbility to analyze training needs and situations to determine if performance can be improved through trainingAbility to work independently on assignments of moderate to high complexityCourage to face difficult issues, and to provide direct and actionable feedback despite dissent or political riskStrong interpersonal skills and demonstrates respect for the opinions of othersProfessional qualifications and experience:Experience in technical insurance claims auditing required, preferably as a QA ManagerDemonstrable extensive experience in Claims Quality Assurance in a P&C insurance environment. International experience is preferredA degree educated professional, preferredDemonstrative 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 tablesCompetencies:As a leader within Claims must champion the Everest Insurance Culture:Collaboration: Open and transparent communication with customers and colleaguesDiversity, Equity, and Inclusion: Through a welcoming and open environment that values all individualsThoughtful 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 enterpriseExecution: Delivering outstanding support to the organization through strong day-to-day business operations, effective project management, and careful oversight of vendorsHumility: Caring and respectful approach to service colleagues, customers, and the communityLeadership: By example, every dayThe 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. #LI-Hybrid#LI-AS1Type:RegularTime Type:Full timePrimary Location:Warren, NJAdditional Locations:Philadelphia, PA, Stamford, CTEverest is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy), sexual orientation, gender identity or expression, national origin or ancestry, citizenship, genetics, physical or mental disability, age, marital status, civil union status, family or parental status, veteran status, or any other characteristic protected by law. As part of this commitment, Everest will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Everest Benefits at ...@everestglobal.com.Everest U.S. Privacy Notice | Everest (everestglobal.com)