Job Description
The Specialist, National Claims Quality Assurance, will lead the implementation and execution of a technical file review program within the claims area of the business including coverage of multiple regions / jurisdictions. This Line 1B defense mechanism for Claims ensures our claims file handlers and leaders are :
- Meeting customer expectations
- Ensuring case reserves are timely and accurate
- Managing claims according to regulatory requirements
- Adhering to other file handling practices to Economical standards
What can you expect in this role?
Work with Claims VPs and Directors, Actuarial and Insurance Risk teams - within Auto claims operations to drive claims handling insights and impact while supporting Claims in their action planning and resolutionReport the results of these reviews into 2 new sub-committees (Claims Risk & Control and Reserving committee / sub-committee) to promote a strong risk and control environmentSupport the development of claims technical file review audit methodology framework and processesProvide input / insight in developing the annual audit planSupport the development of audit quality standards for each step of the audit process such as : testing scripts and interpretation notes, working papers, etc.Complete file reviewsMake recommendations on findings, agreeing with key claims stakeholders to appropriately manage risksReport findings to Risk & Reserving committees, senior leaders and other key stakeholders as requiredManage internal and external resources supporting this workRecommend and influence any necessary changes to company policies, guidelines and best practicesEnsure all reviewers (Claims Leaders, Claims Technical Advisors, Claims Quality Assurance) are calibrated for a consistent approach in auditing claims filesObtain agreement with Claims Leaders and Claims Technical Advisors on establishing best-in-class standards for audit and minimum thresholds for lines of business and file handling performance, including developing leakage methodologyIncorporate data analytics to measure and monitor adherence to regulatory and company standards, including idea generation, designing automated testing procedures and investigating potential gaps and incorporating findings into the reporting processProvide advisory and consultative services on claims file management, claims process effectiveness, risk management and control on new initiatives, process changes, existing processes and from ad hoc requestsProblem solving from root cause analysis on issues to developing and implementing solutionsWork with Claims, Actuarial, Risk, IT, Legal & Compliance, Finance and UnderwritingFoster awareness of the company's policies and procedures through regular communication, training and employee engagementHelp to implement any new requirements, controls, close action items as needed, including assisting with new regulatory requirements, process and controls mapping / documentation, framework updates and / or developmentMonitor emerging best practices in risk management, audit and control to improve the organization's ability to identify, assess, mitigate, govern and reportDevelop techniques to make control testing more efficient and effectiveWhat do you bring to the role?
Strong 5+ years claims career including; 5+ years of Auto Adjusting and / or Auto Claims Appraisal experienceMulti-line claims handling experience is an asset but not necessaryExperience in audit, risk management, regulatory compliance, processes and controls is preferred but not necessaryExperience as a claims leader is an asset but not necessaryStrong stakeholder management skillsStrong understanding of business operations and related legislative, regulatory and internal policy and procedure requirementsExcellent analytical, written and verbal communication skillsAbility to build strong relationships externally and internally at all levels to help foster a positive compliance cultureProficient in Excel, Powerpoint and WordStrong organizational and problem-solving skills with the ability to gather information, analyze critically and cut through complexities to arrive at workable solutionsStrong level of personal integrityHighly Positive attitude and open mindedThrives in a team environment and ability to also work independentlyBilingualism is an assetSalary range $55,800 - $102,800
About Us
Interested in this role, but don’t meet every requirement? We encourage you to apply! We know from experience that a candidate doesn’t need 100% of the qualifications listed to bring incredible value to our team. We’re actively seeking diverse backgrounds and perspectives to help us make insurance better. At Definity, inclusion, diversity, and equity aren’t just “nice to have” — they’re essential to our success.
What’s in it for you?
Hybrid work schedule for most rolesCompany share ownership programPension and savings programs, with company-matched RRSP contributionsPaid volunteer days and company matching on charitable donationsEducational resources, tuition assistance, and paid time off to study for examsFocus on inclusion with employee groups, support for gender affirmation surgery, access to BIPOC counsellors, access to programs for working parentsWellness and recognition programsDiscounts on products and servicesActual salary for the role may vary depending on work location of the successful candidate and other factors including but not limited to, skills, education, experience, working conditions and the local labour market. In addition to base pay, eligible employees may participate in various incentive plans which are paid out at the discretion of the company and subject to individual and company performance.
Go ahead and expect a lot — you deserve it.
Our inclusive work environment welcomes diversity and supports accessibility. If you require accommodation at any time during the recruitment process, please let us know by contacting .
Background checks
This role requires successful clearance of background checks (including criminal checks and leadership references).
