Claims Quality Audit Manager jobs in Michigan

SUMMARY:

Perform production and quality audits to ensure operations are effective, consistent and in compliance with business rules and processes. Primary focus includes, but is not limited to, auditing the claim support and business development support functions. Responsible for performing administrative and support tasks which may be highly confidential and sensitive in nature.

PRIMARY RESPONSIBILITIES: 

· Completes production and quality audits, reviewing completed work in comparison to established documented procedures to determine accuracy.

· Collaborate with management and stakeholders to ensure understanding, alignment and consistency in workflow performance.

· Partner with training, management and stakeholders to identify training needs based on quality assessment results Compiles, creates, prepares, and reviews for accuracy, information and reports as requested or scheduled. This includes analyzing trends and data, creating reports.

· Participates in review of process changes with a clear focus on the potential impact to quality, accuracy and results.

· Coordinates the impact of regulatory changes and updates to policies, practices and procedures and works closely with managers and stakeholders to appropriately translate the updates to the end user.

· Perform audits of training to provide feedback on comprehension and adoption of the training. May attend training sessions to understand changes to processes, regulations and workflows.

· Reviews, evaluates and makes recommendations for process improvements.

· Assists in the creation of departmental procedures and reference documents.

· May be required to perform work in the Operations and/or Service Center teams, or perform other activities in order to maintain or gain knowledge of current processes, procedures and systems relative to the areas of auditing for which they are responsible.

· Participates in projects as assigned.

· Perform audit related investigation to troubleshoot error trends as it relates to business processes and/or training. May be responsible for researching operational audit best practices and making recommendations for improvement.

· Maintains confidentiality of all information processed.

This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

A. EDUCATION REQUIRED:

Associate’s Degree in insurance, business or a related field. Combination of relevant education and work experience may be considered in lieu of a degree.

B. EXPERIENCE REQUIRED:

Two (2) years experience with AF Group within the Claims, Business Development, Finance, Service Center or equivalent Enterprise experience that provides the necessary skills, knowledge and abilities.

OR

Three (3) or more years experience in an insurance organization which provides working knowledge in one or more of the following areas: claims management, underwriting, finance or auditing.

C. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

· Working knowledge of Workers Compensation claims and/or business development procedures, workflows, and rules for multiple states.

· Excellent analytical skills to identify opportunities for improvement and recommend solutions.

· Ability to comprehend consequences of various situations to make appropriate individuals aware of same for decision making.

· Strong analytical and problem solving skills.

· Ability to effectively exchange information clearly and concisely, present ideas, report facts and other information, and respond to questions as appropriate.

· Ability to read, analyze and interpret policy documents, technical, legal and financial information, and procedures manuals.

· Excellent verbal and written communication skills.

· Ability to manage multiple projects and meet necessary deadlines.

· Basic knowledge of computers, spreadsheet software, and word processing and ability to enter accurately 50 WPM.

· Ability to perform mathematical calculations.

· Ability to proofread documents for accuracy of spelling, grammar, punctuation and format and edit as necessary.

· Ability to maintain confidentiality.

D. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED: 

· Ability to create surveys and survey criteria.

· Completion of industry recognized quality or internal audit certification(s).

· Advanced knowledge of industry best practices related to sound internal controls and audit techniques.

· Ability to assist in the development and implementation of policies, practices, and procedures.

· Bachelor’s degree in Business.

· Insurance education coursework.

· Certification or progress toward certification in courses focused on but not limited to Quality Auditor, Quality Manager, Six Sigma or other quality designations is highly preferred and encouraged.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Minimal travel.

REQUIRED TESTING: 

Basic Excel, Reading Comprehension, Math, Typing 50wpm, Proofreading, Basic Word, and Basic Windows