Claims QA Analyst

SUMMARY:

This position is responsible for monitoring and reporting on Claims processes to ensure adherence to statutory compliance guidelines as well as established company performance and quality standards . Key Claim metrics are monitored, compiled, and communicated to maintain high quality standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Maintains excel reports to document adherence to key quality metrics in areas such as adequate claim reserves, timely first contact, phone measurements, coverage explanations, Diary utilization, etc. The report data is compiled from emails and applicable company software systems.
• Sends timely email reminders and communication to ensure appropriate process and quality protocols are maintained throughout the claim cycle.
• Conducts claim file audit reviews for examiners as well as other quality assurance projects.
• Collects, analyzes, and reports data from the Claims system to supply analytical results to management to ensure we are meeting each measured SOX requirement, as well as ensuring we are following the Heritage best practices.
• Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs.
• May perform special projects or other duties and responsibilities as assigned.
• Communicates with co-workers, management and others as needed in a courteous and professional manner.
• Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures.

KEY COMPETENCIES:

• Quality - Strives to eliminate errors, accurate work is a priority, seeks opportunities to improve product/services
• Organization Skills - Information organized and accessible, maintains efficient work space, manages time well• Job Knowledge - Understands facets of job, aware of duties and responsibilities, keeps job knowledge current
• Productivity - Manages workload, works efficiently, meets goals and objectives
• Teamwork - Accountable to team, works to meet established deliverables, appreciates view of team members, respectfu

OTHER QUALIFICATIONS REQUIRED:

• • HS or Equivalent, Some College Preferred
  • Insurance Claims Handling Knowledge
  • Proficiency with Microsoft Office programs required, Excel, Word and Outlook
  • Demonstrated customer service focus
  • Strong communication and interpersonal skills
  • Results driven with strong problem solving and analytical skills
  • Ability to work independently in a fast-paced environment; meet deadlines and manage changing priorities effectively
  • Very detail-oriented
  • Exceptional organizational skills
  • Collaborative partner; ability to contribute to a positive work environment.

General Information:

All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc.

The preceding job description has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Heritage Insurance Holdings, Inc. is an Equal Opportunity Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.