Claims Quality Specialist, Governance (Quebec-bilingual)

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 1 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 Definity standards

What can you expect in this role?

• Work with Claims VPs and Directors, Actuarial and Insurance Risk teams within the Quebec region to drive claims handling insights and impact while supporting Claims in their action planning and resolution
• Report findings and results (Claims Risk & Control and Reserving committee / sub-committee) to promote a strong risk and control environment, Risk & Reserving committees, senior leaders and other key stakeholders as required
• Support the development of claims technical file review audit methodology framework and processes
• Provide input / insight in developing the annual audit plan
• Support 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 reviews
• Make recommendations on findings, agreeing with key claims stakeholders to appropriately manage risk
• Manage internal and external resources supporting this work
• Recommend and influence any necessary changes to company policies, guidelines and best practices
• Ensure all reviewers (Claims Leaders, Claims Technical Advisors, Claims Quality Assurance) are calibrated for a consistent approach in auditing claims files
• Obtain 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 methodology
• Incorporate 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 process
• Provide 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 requests
• Problem solving from root cause analysis on issues to developing and implementing solutions
• Work with Claims, Actuarial, Risk, IT, Legal & Compliance, Finance and Underwriting
• Foster awareness of the company's policies and procedures through regular communication, training and employee engagement
• Help 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 development
• Monitor emerging best practices in risk management, audit and control to improve the organization's ability to identify, assess, mitigate, govern and report
• Develop techniques to make control testing more efficient and effective

What do you bring to the role?

• Strong 10+ years claims career including; 5+ years as Sr. Adjuster and / or Specialist
• Experience in minimum 2 lines of claims business (Auto, Property, Bodily Injury / Casualty)
• Experience in audit, risk management, regulatory compliance, processes and controls is preferred but not necessary
• Experience as a claims leader is an asset but not necessary
• Strong stakeholder management skills
• Strong understanding of business operations and related legislative, regulatory and internal policy and procedure requirements
• Excellent analytical, written and verbal communication skills
• Ability to build strong relationships externally and internally at all levels to help foster a positive compliance culture
• Proficient in Excel, Powerpoint and Word
• Strong organizational and problem-solving skills with the ability to gather information, analyze critically and cut through complexities to arrive at workable solutions
• Strong level of personal integrity
• Highly Positive attitude and open minded
• Thrives in a team environment and ability to also work independently
• Bilingualism is mandatory (French / English)

Salary Range : $66,300 - $122,100

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 roles
• Company share ownership program
• Pension and savings programs, with company-matched RRSP contributions
• Paid volunteer days and company matching on charitable donations
• Educational resources, tuition assistance, and paid time off to study for exams
• Focus on inclusion with employee groups, support for gender affirmation surgery, access to BIPOC counsellors, access to programs for working parents
• Wellness and recognition programs
• Discounts on products and services

Actual 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).