Senior Quality Improvement Specialist - Claims Audit, Auto

Farm Family

Farm Family specializes in farm and ranch protection with a wide range of products including flexible farm packages, business owner policies, commercial package, workers compensation, commercial auto and select personal auto coverage. Farm Family is a leader in serving the Northeast and Mid-Atlantic markets and is pursuing growth across the U.S. The Farm Family entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.

Business Title(s): Senior Quality Improvement Specialist

Employment Type: Full-Time

FLSA Status: Exempt

Location: In Office
- Any employee, in any Clearbrook office, can apply for this opportunity and stay in their current location.
Summary:

We are looking for a highly effective Senior Quality Improvement Specialist to join our team and work from our Omaha office. Alternatively, we can fill this position in our Albany, Chicago office. The Senior Quality Improvement Specialist conducts data-driven quality claim audits of Handlers' claims files in order to evaluate claims handling and outcomes against enterprise standards, consistent processes, governance, and level of quality.

The Senior Quality Improvement Specialist will provide feedback to the claims management team and recommend steps necessary to improve claims quality and outcomes, which may include process improvements, training or performance management.

This is a 100% in-office position. Candidates must be able to work on-site at a designated company office during standard business hours.

• Under technical supervision and working within significant limits and authority, conduct and document data-driven claim audits in the designated audit system within established timelines, having a direct impact on department results.
• Evaluate claim files for adherence to enterprise standards and gaps between actual and optimal claims outcomes, including but not limited to the areas of coverage analysis, liability, estimates, accurate and timely reserving, documentation, and compliance with internal standards, regulatory requirements, and quality expectations.
• Analyze audit results and perform focused audits on specific trends as needed to identify gaps and opportunities for improvement.
• Translate audit findings into training, process improvements, and performance actions to claims staff and leadership.
• Escalate critical findings and provide immediate feedback to leadership when urgent action is needed on a claim.
• Participate in internal calibration activities within the Quality team to ensure scoring consistency.
• Partner with leadership to support training initiatives and process improvements.
• Consistently demonstrate exceptional customer service and appropriate technical expertise, maturity and a professional commitment to excellence.
• Having an appreciation and passion for data analysis, process improvement, and training that elevates strong claim management throughout the department.

• A broad theoretical knowledge of general liability claims as well as an exceptional customer service focus typically obtained through:
• Minimum of two years of direct auto, bodily injury, liability, or PIP handling experience, with emphasis on complex, high severity commercial losses coverage, reserving, litigation management, and claim strategy expertise.
• Bachelor's degree from an accredited university required. Two or more insurance designations or four additional years of related experience adjudicating claims beyond the minimum experience required above may be substituted in lieu of a degree.
• Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Farm Family and our customers' ability to…