Quality Analyst

3 weeks ago

Mandaluyong, Philippines Chubb Full time

Overview

Role Purpose: The primary responsibility of this role is to audit claims to ensure compliance with the Company’s Operational Guidelines (COG) standards.

Responsibilities
  • Conduct thorough audits of claims to assess compliance with COG standards and internal policies.
  • Review and analyze claims documentation, ensuring accuracy and completeness.
  • Identify discrepancies, errors, and areas for improvement in claims processing.
  • Prepare detailed reports on audit findings, including trends and recommendations for corrective actions.
  • Collaborate with claims processing teams to provide feedback and training on quality standards and best practices.
  • Monitor and track the implementation of corrective actions and improvements based on audit findings.
  • Stay updated on industry regulations, standards, and best practices related to claims processing and quality assurance.
  • Assist in the development and refinement of quality assurance processes and tools.
  • Participate in regular quality review meetings and contribute to continuous improvement initiatives.
  • Support the Manager in special projects and initiatives as needed.
  • Supports Claims trainer in conducting product training.
  • Conduct audits of claims during new hire training certification exams.
Experience
  • Minimum of 3 years of experience in claims processing, auditing, or quality assurance within the insurance or healthcare industry.
  • Strong understanding of claims management processes and COG standards.
  • Excellent analytical and problem-solving skills with a high attention to detail.
  • Proficient in using claims management software and Microsoft Office Suite (Excel, Word, PowerPoint).
  • Strong communication skills, both written and verbal, with the ability to present findings clearly and effectively.
  • Ability to work independently and collaboratively in a team environment.
  • Ability to develop and implement appropriate claims management strategies and plans.
  • Sound knowledge of claims administration procedures and related systems.
Qualifications
  • Tertiary Qualified or minimum 3-4 years similar work experience
  • Claims Insurance background is required
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