Senior Quality Improvement Specialist

Brookfield Wealth Solutions, Ltd•Albany, NY

4d•Onsite

About The Position

We are looking for a highly effective Senior Quality Improvement Specialist to join our team and work from our Omaha office. Alternatively, we can fill this position in our Albany, Chicago office. The Senior Quality Improvement Specialist conducts data-driven quality claim audits of Handlers’ claims files in order to evaluate claims handling and outcomes against enterprise standards, consistent processes, governance, and level of quality. The Senior Quality Improvement Specialist will provide feedback to the claims management team and recommend steps necessary to improve claims quality and outcomes, which may include process improvements, training or performance management. This is a 100% in-office position. Candidates must be able to work on-site at a designated company office during standard business hours.

Requirements

A broad theoretical knowledge of general liability claims as well as an exceptional customer service focus typically obtained through:
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.
Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Farm Family and our customers’ ability to be profitable).
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 by:
Finding a way to achieve success through adversity.
Being solution (not problem) focused
Thinking with a global mindset first.
Successful traits (flexibility, ability to thrive in change, being resourceful on your own) necessary to work in a fast paced environment that is evolving constantly.
Must work independently and demonstrate the ability to exercise sound judgment. This role primarily faces problems and issues that generalized and typically not complex, but require an understanding of a broader set of issues.
Exhibit natural and intellectual curiosity. Consistently considers all options and is not governed by conventional thinking.
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

Under technical supervision and working within significant limits and authority, conduct and document data-driven claim audits in the designated audit system within established timelines, having a direct impact on department results.
Evaluate claim files for adherence to enterprise standards and gaps between actual and optimal claims outcomes, including but not limited to the areas of coverage analysis, liability, estimates, accurate and timely reserving, documentation, and compliance with internal standards, regulatory requirements, and quality expectations.
Analyze audit results and perform focused audits on specific trends as needed to identify gaps and opportunities for improvement.
Translate audit findings into training, process improvements, and performance actions to 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.
Having an appreciation and passion for data analysis, process improvement, and training that elevates strong claim management throughout the department.