Claims Audit

**The Role**:
**The QA Audit and Complaint Handler will**:
Assist with audits across all lines of business and claims handling centres.
Handle claim related complaints within the Regulatory and company framework and timescales.
Conduct root cause analysis of complaints to determine required procedural changes and training needs.
Measure and report on claim handling quality and customer outcomes.
Assist with the development and monitoring of action plans to remediate sub optimal results.
Engage with Claims Managers to deliver action plans and training plans.
Help drive continuous improvement initiatives, best practice guidance and standard operating procedures.
Assist with the production of management information and improvement tracking to evidence outcomes.

This is an integral role in the claims function ensuring quality standards are continuously improved ensuring the PIB reputation for customer experience and service excellence are evidenced by a robust Quality Assurance and complaint handling regime.

**Responsibilities**:

- Work closely with the QA Manager to deliver a robust and sustainable QA model, one that drives continuous improvement in both technical and service delivery.
- Help maintain the reporting model where results can be tracked, are visible to both claims personnel and management as part of the annual performance appraisal process, helping to improve individual and team performance.
- Investigate and respond to expressions of dissatisfaction and complaints from eligible complainants.
- Own and report on complaint outcomes.
- Be the point of contact across the Division for complaint queries and concerns (whether internal, via FOS or outsourced providers).
- Provide training to the Division on complaints and the Quality Framework - including new starters, refresher, and regulatory changes.
- Assist with the production of monthly and quarterly management information reports to all stakeholders.
- Help build out remediation plans, implement a lessons learned culture and ensure there is a continuous feedback loop to the claims teams to ensure performance issues are resolved.
- Assist with agreeing remediation activity with Claims Managers that can be drafted into action plans for Claims Managers to implement and remediate.
- Support best practice initiatives and process improvement across all claim types.
- Work with the QA Manager to establish a high performing culture measured through meaningful KPI's and SLA's.
- Collaborate and engage across functions and departments in order to work with all stakeholders within the PIB Group involved in the delivery of a superior customer excellence programme.

**Experience**:

- Experience with, and a full understanding of the insurance claims process across multiple lines of business.
- Resolving complex complaints within a Regulatory Framework
- Reviewing and auditing claim files against a best practice guidance document
- Analysing management information reports identifying trends and issues
- Creating action plans to remediate sub optimal performance and maintain and optimise performance.
- Driving change through continuous improvement initiatives.
- Implementing sustainable change.
- Root cause analysis techniques.
- Providing feedback to remediate and reduce causes of complaints.
- Introducing a "lessons learned" culture.
- Strong planning and organisational capability.
- Report writing and communication expertise.
- Analysis on MI for audit results.
- Managing the claims process and determining best practice.
- Influencer across all levels of the organisation.
- Empathetic approach to complaint resolution.
- Strong sense of brand and reputation for service excellence.
- Has good judgment, a sense of urgency and has demonstrated commitment to high standards of ethics, regulatory compliance, customer service and business integrity.
- Understands the individual component parts of the claim process:

- FNOL, data integrity, accuracy, completion, reserving, settlement procedures.
- Industry best practice.
- Insurer operating model for claim management.
- Calibration, rating and audit scoring methodology.
- Complaint management - empathy, root cause analysis, remediation techniques.
- Engagement with stakeholders to explain and manage complaint outcome issues.
- Production of metrics and the use of data as a reporting tool to illustrate performance issues and improvement progress.
- Conduct issues as determined by the Regulator and PIB best practice guidance.

**Further information**:
As well as a competitive salary we offer the following benefits -- Competitive holiday allowance with the annual option to buy additional days.
- Death in Service benefit of x4 salary
- Company pension scheme
- Very generous maternity and paternity leave packages
- A flexible benefits package which allows you to add additional benefits to your overall package
- Our benefits portal offers discounts on technology & electronics, cinemas, restaurants, days out, mortgage advice, travel and many more
- Referral schemes
- Discounted rates on PIB products
- We offer a first-class employee benefits and welfare package to support our employees with financial management, cycle to work scheme, counselling support, health screening, will writing, menopause support, books, stopping smoking and much more
- We also offer a wide range of discounts including a kids pass - giving you discount to over 4500 attractions and activities, discounts at hairdressers and beauticians, climate change projects with lots of other options to choose

REF-207945