QI Specialist Medical

Liberty Mutual InsuranceUnited StatesRemoteFull-timeMid level, 2–5 yearsListed 4 hours ago

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About this role

Description

Under direction, reviews and analyzes assigned line of business to determine accuracy and compliance with claims handling standards. Assists and participates in calibration training, analysis of results, development of QI reporting and presentation of findings. Facilitates calibration of quality improvement team. Assists management in compiling and analyzing results and presenting findings to claims management. Participates in and/or facilitates smaller size operational RCPS events and provides support for implementation of improvements.

**This is a 2-year development program that has been designed to build and develop capabilities and professional acumen to prepare you for future roles at Liberty Mutual.

This is a range Grade 11 - 13.

Responsibilities

- Under limited direction, conducts file reviews.

- Analyzes all aspects of claims handling and communication.

- Determines compliance with claims handling standards, policies and procedures as determined by calibration.

- Under limited direction, analyzes results and develops the necessary detail from audits conducted to assist the QI team in identifying the trends from an audit which, if corrected, would drive improvement.

- Accurately tracks and inputs audit findings into database.

- Participates in calibration with File Review team and the analysis of overall results.

- Under limited direction, assists in the preparation and leads presentation of results, conclusions, and recommendations to field leadership on less complex claims.

- Assists with driving continuous improvements by providing feedback on audit process and tool changes that will result in a better product being delivered to the line of business.

- Performs other duties as assigned.

This is a remote position. For candidates who reside within 50 miles of a hub office will be required to go in office 2 days per month. Please note this policy is subject to change.

Qualifications

- A minimum of 3-5 years of directly related experience required

- Associate's or Bachelor`s degree strongly preferred

- Strong written and oral communication skills required

- Strong interpersonal and analytical skills required

- Comprehensive knowledge of Claims department procedures required

- Knowledge of assigned line of business, general insurance policy coverage and State Tort Law

Employees may apply for a new role after completing 12 months of employment in their current position.

Employees should review all role requirements and apply only for positions for which they are eligible. Hiring processes may vary by country, including differences in procedures, requirements, and timelines. For country-specific details, please consult your local recruiting / HR team.

## Travel
10%