This Manager, Claims Quality & Compliance is responsible for leading the quality and compliance functions within the Claims organization and partnering with leaders and other organizational stakeholders. The successful candidate will manage all Claims quality and compliance programs, including the buildout of Claims specific state and regulatory compliance strategies, reporting, trending and ensuring conformance to regulations. They will also build out the quality program, and establish measures of excellence based on evidence-based, industry-standard quality, reporting, trending, and execution strategies for both the new hire and ongoing adjudicate teams (Workers' Compensation and Commercial Auto). In addition, the candidate will be responsible for constructing TPA auditing best practices and execution, and managing, leading, and developing all compliance and quality staff.

How You’ll Do It

• Own all claims quality processes, systems, and reporting requirements

• Assess current state of new hire and ongoing quality programs; iterate and create for continued success and improvement of these programs.
• Track efficacy of quality and auditing programs and utilize data for continued growth and improvement; including development of quality metrics for various claims departments.
• Develop internal best practices for first notice of loss, claim handling, medical management, and litigation management.
• Manage the technologies and tools required to develop, manage, and deliver quality metrics.
• Verify and maintain accuracy of claims quality data.
• Develop quality reporting best practices and drive action plans for improvement based off leading indicators and evidence-based quality standards.

• Creation of claims specific compliance strategy and regulatory reporting

• Collaborate with Claims senior leaders and Claims Learning & Development (L&D) Manager to create and maintain training to further the compliance knowledge of all Claims staff.
• Assist in identifying and executing towards jurisdictional and federal regulatory requirements.
• Working collaboratively with Pie's legal counsel and other stakeholders in executing all responsibilities and in supporting and advancing compliance.
• Oversee EDI And CMS reporting for multiple lines of business, including compliance training, monitoring plans, executing timelines and identifying appropriate resources.
• Manage the technologies and tools required to develop, manage, and deliver compliance metrics.
• Verify and maintain accuracy of claims compliance data.
• Develop compliance reporting best practices and drive action plans for improvement based on leading indicators and evidence-based findings.
• Partner with the Organizational Compliance team to ensure regulatory compliance and reporting is aligned with organizational strategy, escalate any compliance issue to broader compliance and senior leadership team.

• Cross-functional collaboration and communication

• Promote a claims and customer service excellence culture within Pie that emphasizes continuous learning and development.
• Collaborate with the Claims L&D team to update and maintain training materials and tools (i.e., decks, pdfs, eLearning, and reference materials) to reflect updated processes and company changes.
• Collaborate with Claims leadership to help educate staff on quality finding and themes, mitigate future quality opportunities, and enhance quality metrics and measures. Provide timely and effective communication to the Leadership Team regarding quality trends.
• Collaborate with other departments and teams, including but not limited to the Claims L&D, WC Claims, Commercial Auto Claims, Organizational compliance and SIU teams to obtain voice of the customer and support cross-departmental projects as required.

• People Management

• Hire and develop claims quality and compliance specialists by identifying opportunities for growth and the skills needed for the team's success.
• Manage the onboarding, coaching, and development of a team of both quality and compliance specialists.
• Set strategy and goals for Claims Quality & Compliance personnel in alignment with larger Claims goals and KPIs.
• Demonstrated leadership and performance management capabilities to guide and inspire Claims Quality & Compliance personnel to achieve KPIs.

The Right Stuff

• 3+ years of Workers' Compensation and Commercial Auto claims preferred
• 3+ years of Quality and Compliance/Regulations experience in the P&C insurance industry
• 3+ years of leadership experience
• Advanced communication (written, verbal and presentation) skills, to deliver complex information effectively and align people with the needs of the project/team
• Advanced problem solving skills, to be able to manage complex situations with multiple layers, and resolve to solution anticipating needs now and into the future.
• Advanced awareness of your own and your team's tasks, and how it impacts the organization and deliverables
• Advanced leadership skills with experience leading large or technical teams through complex deliverables.
• G-Suite Tools, Excel, and Collaboration tools (Slack is preferred), Understanding of telephony platforms.
• High School diploma or GED required, Bachelor's Degree preferred

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