QA Manager

SUMMARY
Under the general direction of the Director of Quality Assurance the incumbent is responsible for managing all aspects of annual and special quality audits to include scheduling, developing audit criteria, leading the audit team, managing the rebuttal process and preparation and delivery of the formal report to management.

ESSENTIAL FUNCTIONS
1.Provides direct management of the Quality Assurance Department. Develops audit criteria, directs the audit team, oversees the audit process and creates and delivers audit findings.
2.Establishes trending benchmarks and continuously monitors and evaluates productivity and quality measures. Assumes accountability for the identification of negative trends and elevates concerns and recommendations to the Director.
3.Assesses Company reserve adequacy.
4.accountable for Branch compliance to all Plans of Correction.
5.Develops and maintains superior customer relationships. Requires frequent factual and unbiased communication as a quality control expert to Senior Management, Branch Managers and others.
6.Exhibits superior technical knowledge of the Companies Best Practice, Policy and Procedures and Workers’ Compensation law and Regulations that govern the administration of claims in all of the states in which our company does business. Utilizes problem-solving skills to address inquiries and resolve issues timely and effectively. Solicits input from supplemental resources such as the medical advisors, claims teams, and nurses when required.
7.Assists the Director in identifying training needs for Corporate Claims staff. Participate in creating and presenting training material and programs.
8.Assists the Director in creating and analyzing workflow and Policies and Procedures.
9.Reviews worksheet accuracy and approves reserve changes on large loss claims.
10.Demonstrates leadership by creating an environment that fosters teamwork, values diversity, and which supports and respects all team and company staff-members, internal and external customers, and vendors. Is responsible for selecting, managing, developing, coaching, and motivating team members.
11.Other duties as assigned or as situation dictates.

WORKING CONDITIONS
•Working conditions are typical of a fast paced office environment.
•There may be occasional lifting up to 50 pounds, and frequent lifting up to 10 pounds.
•Position entails prolonged sitting, data entry, and written and verbal communications.
•Travel to offsite locations may be required up to 30% of the time.
REQUIREMENTS
MINIMUM QUALIFICATIONS / KNOWLEDGE, SKILLS & ABILITIES
•Must demonstrate technical competency in managing Workers’ Compensation claims and have regulatory expertise in applicable states, or any equivalent combination of education and experience.
•Must have prior project management experience to include coordinating resources, estimating timeframes, determining completion dates and monitoring progress.
•Must have previous experience as a manager or supervisor.
•Must be able to demonstrate the ability to gather and analyze data.
•Must be able to identify and anticipate problems or issues and recommend solutions.
•Experience with report preparation and presentation to senior management is required.
•Must have demonstrated skills in interpreting, understanding, and applying statutes, regulations, company policies, and procedures.
•Must have the ability to remain unbiased and maintain a professional demeanor, even when interacting with difficult customers.
•Must have exceptional verbal and written communication skills.
•The ability to maintain confidentiality is required.
•Must demonstrate a high level of computer proficiency with Microsoft Office.
•Must have excellent English oral and written communication skills.
•Must be able to multi-task. Must have High School diploma or GED equivalent.
•Must demonstrate a commitment to continuing education through completion of structured leadership and/or technical training.

PREFERRED, BUT NOT REQUIRED
•Internal candidates who have completed the Quality Assurance Internship Program are preferred. A Certificate of Self-Insurance in applicable state is desirable.
•Technical knowledge of multiple states Workers’ Compensation laws, particularly in states in which we have business, is encouraged.
•AIC, ARM, or CPCU certification preferred.
•Completion of Leadership training or equivalent management skill training is desired.
•Multi-state and multi-line experience is desirable.


The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job. There may be times when, at management’s discretion, you will be expected to perform additional assignments that are necessary for business reasons.