Senior Quality Improvement Specialist

BP&C•Omaha, NE

3d•Onsite

About The Position

Farm Family is seeking a highly effective Senior Quality Improvement Specialist to join their team. This role is responsible for conducting data-driven quality claim audits to evaluate claims handling and outcomes against enterprise standards, consistent processes, governance, and quality levels. The specialist will provide feedback to the claims management team and recommend improvements, which may include process enhancements, training, or performance management. This is a 100% in-office position, requiring candidates to work on-site at a designated company office during standard business hours. The role involves conducting and documenting audits, evaluating claim files for adherence to standards and identifying gaps, analyzing audit results, and translating findings into actionable improvements. The specialist will also escalate critical findings, participate in calibration activities, partner with leadership on training and process improvements, and consistently demonstrate exceptional customer service and technical expertise. A passion for data analysis, process improvement, and training is essential.

Requirements

Minimum of two years of direct auto, bodily injury, liability, or PIP handling experience, with emphasis on complex, high-severity commercial losses coverage, reserving, litigation management, and claim strategy expertise.
Bachelor’s degree from an accredited university required. Two or more insurance designations or four additional years of related experience adjudicating claims beyond the minimum experience required above may be substituted in lieu of a degree.
Good business acumen (understanding how an insurance company works and makes money, including how this role impacts profitability).
Demonstrated ability to translate Quality Audit findings into measurable claim quality improvements, operational changes, training priorities, and performance management actions.
Experience using structured feedback loops to claims management and claim handlers to ensure Quality Audit findings result in timely corrective action and sustained improvement.
Excellent written and verbal communication skills, including the ability to prepare clear summaries, findings reports, and presentations.
A strong focus on execution in getting things done right.
Proven ability to consistently produce and deliver expected results to all stakeholders.
Flexibility, ability to thrive in change, and resourcefulness to work independently in a fast-paced, evolving environment.
Must work independently and demonstrate the ability to exercise sound judgment.
Proficient in MS Office Suite and other business-related software.
The ability to read and write English fluently is required.
Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.

Nice To Haves

Experience working with Guidewire and Athenium auditing platforms and CCC.
Experience developing and presenting training materials based on Quality Audit results, claim handling trends, system utilization gaps, and identified performance opportunities.

Responsibilities

Conduct and document data-driven claim audits in the designated audit system within established timelines.
Evaluate claim files for adherence to enterprise standards and gaps between actual and optimal claims outcomes, including coverage analysis, liability, estimates, reserving, documentation, and compliance.
Analyze audit results and perform focused audits on specific trends to identify gaps and opportunities for improvement.
Translate audit findings into training, process improvements, and performance actions for claims staff and leadership.
Escalate critical findings and provide immediate feedback to leadership when urgent action is needed on a claim.
Participate in internal calibration activities within the Quality team to ensure scoring consistency.
Partner with leadership to support training initiatives and process improvements.
Consistently demonstrate exceptional customer service and appropriate technical expertise, maturity, and a professional commitment to excellence.
Exhibit natural and intellectual curiosity, consistently considering all options and not being governed by conventional thinking.