Quality Assurance Specialist, Claims Support
NYCM Insurance
full-time
Posted on:
Location Type: Hybrid
Location: Edmeston • New York • 🇺🇸 United States
Visit company websiteSalary
💰 $41,156 - $57,563 per year
Job Level
Mid-LevelSenior
About the role
- Review and evaluate samples of claim files for compliance with Best Practices and State Regulations.
- Aid in the company meeting prompt and fair settlement loss standards.
- Identify areas of opportunity for improvement and/or training in reviews and claim processes.
- Communicate all findings effectively with examiners and management.
- Perform Focus Audits for compliance as requested by management.
- Conduct Regulation reviews and Reg 118 reviews.
- Review claims for proper coverage verification and determine loss exposure as applicable.
- Analyze documents received on claims and compile reports for management review.
- Stay updated on procedural changes that affect areas of review.
- Perform additional duties as assigned.
Requirements
- High School Diploma
- 3 years of industry experience OR an Associates Degree
- Working knowledge and understanding of NYS Regulations as applicable to the division.
- Full working knowledge and understanding of basic insurance principals, insurance policies, and claims procedures.
- Proficient personal computer skills including electronic mail, record keeping, routine database activity, Microsoft Word, PowerPoint and Excel.
- Excellent and effective oral and written communication skills.
- Effective time management skills.
- Detail oriented.
- Strong decision-making skills.
- Active learner.
- Adaptable, approachable, and kind.
- Ability to work both independently and within a team with minimal direct supervision.
- Critical Thinking.
- Engaged and enthusiastic.
- Ability to accept, absorb and promote change.
- Willingness to engage in authentic conversations.
- Places high value on proactive divisional communication and partnerships.
- Organized; Ability to multi-task and prioritize.
- Ability to build positive professional working relationships.
- Ability to handle stress professionally, calmly, and effectively.
- Positive and professional attitude.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims proceduresinsurance policiescompliance reviewscoverage verificationloss exposure analysisreport compilationNYS Regulationsinsurance principlesFocus AuditsReg 118 reviews
Soft skills
oral communicationwritten communicationtime managementdetail orienteddecision-makingcritical thinkingadaptabilityteamworkrelationship buildingstress management
Certifications
High School DiplomaAssociates Degree