Combined Insurance Claims/QC Manager in United States

Job Title: Claims QC/Manager

Department: Claims

Reports to: Division Manager

Classification: Exempt

Purpose: Manage the loss adjustment, quality control and claim payment processes for the division.

Essential Job Duties and Responsibilities:

  • Contracts and assigns a sufficient number of qualified independent adjusters to assure that policyholders receive prompt, competent adjustment of claims, within approved standards.

  • Assist the Division Manager in the establishment of criteria to audit adjusters’ work product to ensure that proper adjustment procedures have been followed, in accordance with industry standards.

  • Manage large loss and complex claims that may become legal in nature. Manage and build defensive positions on all disputed claims and arbitrations.

  • Schedules adjusters’ school, field days, etc. in conjunction with C.I.T.I., Inc. Assembles and presents loss adjusting information. Keeps current on industry loss adjustment procedures. Updates adjusters and staff on changes.

  • Manages the review and timely response to all oversight and/or audit findings including but not limited to RMA compliance, OIG, State Ins. Department, and Rain and Hail internal audit.

  • Established procedures to assure that adjusters are in compliance with state licensing requirements for the states serviced by the division.

  • Continually reviews and assesses the claims process to identify efficiencies that will result in reduction of our loss adjustment expense and to bring them to the attention of the Vice President of Claims.

  • Manages the Quality Control program of the Division. Assumes day-to-day responsibility for meeting and documenting the adjuster training requirements and the claims audit portion of company Plan of Implementation filed with Federal Crop Insurance Corporation (FCIC).

  • Supervises the claims reporting activity in the internal office and the disposition of claim files to adjusters, in accordance with company established claims procedures. Trains internal claim personnel in procedures for auditing and processing claims files.

  • Monitors loss adjustment expenses for the division and determine methods to improve efficiency and integration with other field activities to reduce costs.

  • Monitors loss ratio results for the states within division territory to ensure that loss experience over time is less than industry average for the same geographic region. Takes corrective action if loss ration consistently exceeds industry average.

  • Utilizes data from the Quality Control program to make recommendations for contract renewals of independent adjusters and agents, in accordance with company approved methodology.

  • Participates in industry state loss committees and assumes a leadership role.

  • Assists with other duties as necessary.

    Knowledge, Skills, and Abilities

  • Comprehensive knowledge of loss adjustment procedures for all products offered by the company.

  • Knowledge of the agricultural industry, including an understanding of the kinds of crops produced in the states serviced by the division; knowledge of agricultural issues.

  • Ability to positively direct the work of others, including the ability to make and communicate assignments, resolve issues affecting employee or adjusters.

  • Knowledge of or the ability to learn Rain and Hail’s products, services and systems.

  • Ability to organize and prioritize multiple tasks.

  • Ability to work in a team oriented environment.

  • Ability to effectively communicate and maintain business relationships with Company personnel, outside resources and customers.

  • Ability to use the Company’s terminology, procedures and systems.

  • Ability to use department equipment.

  • Ability to perform mathematical calculations.

  • Ability to drive a vehicle and maintain a valid drivers license.

  • Ability to remain calm and professional during peak periods of activity.

  • Ability to work from oral and written communication.

  • Ability to maintain confidentiality.

  • Ability to work independently.

  • Ability to travel away from home for extended periods of time and on short notice.

  • Ability to assist in other work-related areas as required.

    Job Qualifications

    Baccalaureate degree in Agricultural Business or related field preferred with 6-8 years of experience.

Job: *Claims

Title: Claims/QC Manager

Location: null

Requisition ID: 320070