Note: The job is a remote job and is open to candidates in USA. EMC Insurance Companies is focused on making an impact through teamwork and collaboration. The Casualty Claims Quality Assurance Consultant will enhance the quality and consistency of casualty claims handling by conducting audits, analyzing performance, and implementing process improvements to drive better outcomes for the business and its customers.
Responsibilities
- Conducts casualty-focused file reviews across Regional, Complex & Specialty teams
- Measures handling quality against EMC Best Practices, Casualty KPIs, and state requirements
- Performs targeted audits on specific casualty focus areas with stakeholders
- Establishes audit standards and procedures with Claims/Casualty leadership
- Documents findings, analyzes trends, and identifies improvement opportunities
- Prepares and delivers audit reports, summaries, and presentations
- Recommends process improvements and future audit focus areas
- Communicates results and action plans to stakeholders
- Supports implementation of new audit processes and continuous improvement efforts
- Provides insights to drive consistency, accountability, and better claim outcomes
- Conducts claims-wide audits with leadership and QA partners as needed
- Adapts audit scope based on evolving business needs and priorities
- Participates in training sessions and shares audit insights with teams
- Assists with special projects, including guideline reviews and KPI-focused initiatives
- Collaborates cross-functionally to ensure audit and project goals are met
Skills
- Bachelor's degree, preferably in insurance, finance, accounting, business administration or related field or equivalent relevant experience
- Eight years of commercial lines casualty claim handling experience, including experience with litigated claims or related experience
- Excellent understanding of the casualty claims function
- Strong understanding of casualty claims handling procedures, principles, standards and best practices
- Strong knowledge of medical and legal terminology and legal aspects of court procedures affecting legal liability
- Ability to audit claim files for consistency
- Strong ability to gather facts, analyze alternatives and recommend solutions
- Excellent organizational and analytical skills
- Excellent customer service and communication skills
- Strong computer skills, including Microsoft Office Suite
- Ability to manage multiple tasks and meet deadlines
- Prior audit experience preferred
- Insurance industry designations (e.g. INS, AIC, CPCU) preferred
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