Skills & Competencies for Claims Quality Audit Manager
Claims Quality Audit Manager job profile
Book a Demo and Receive a Sample Job ProfileJOB SUMMARY for Claims Quality Audit Manager
Manages the claims quality auditors and daily activities of quality claims audit function.
JOB RESPONSIBILITIES for Claims Quality Audit Manager
Reviews and tracks claims quality audit reports and measures performance of auditors. Provides assistance in developing claims audit policies and procedures. May provide coaching in complex claims audit.
Claims Quality Audit Manager SALARY RANGE
BASE 50%
$104,475
TOTAL 50%
$113,410
Job Level
M02
Job Code
HC07000630
Education/Degree
Bachelor's Degree
Reports To
Director or Head of a Department
Claims Quality Audit Manager Skills and Competencies List
7 hard skills or competencies (industry competencies) for Claims Quality Audit Manager
1
Industry Competency –
Insurance Industry
Proficiency Level -2
Level 1 Behaviors
(General Familiarity)
Identifies the key legislation and regulations governing insurance contracts.
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Level 2 Behaviors
(Light Experience)
Records and maintains insurance policy and claims information in a database system.
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Level 3 Behaviors
(Moderate Experience)
Verifies received insurance coverage and damage reports to ensure accurate processing of claims.
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Level 4 Behaviors
(Extensive Experience)
Provides technical guidance to staff on claim investigation to ensure accurate insurance claims processing.
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Level 5 Behaviors
(Mastery)
Pursues creative initiatives that may differentiate our business and give us a competitive advantage.
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2
Industry Competency –
Insurance Legal and Regulatory Environment
Proficiency Level -3
Level 1 Behaviors
(General Familiarity)
Explains the application of insurance regulatory laws to avoid civil penalties and license suspension.
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Level 2 Behaviors
(Light Experience)
Supports the execution of a legal and regulatory framework to promote strict insurance compliance.
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Level 3 Behaviors
(Moderate Experience)
Performs compliance reviews to determine possible violations and deficiencies in insurance regulations.
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Level 4 Behaviors
(Extensive Experience)
Trains teams on new laws and regulations to reduce liability risks and compliance violations.
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Level 5 Behaviors
(Mastery)
Establishes best practices in creating insurance laws and regulations to prevent frauds and malpractices.
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3
Claims Quality Audit Manager
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Claims Quality Audit Manager
Proficiency Level - 4
5
Competency for -
Claims Quality Audit Manager
Proficiency Level - 5
1 general skill or competency (Job family competency) for Claims Quality Audit Manager
1
Job Family Competencies –
Quality Audit
Proficiency Level -3
Level 1 Behaviors
(General Familiarity)
Describes methodologies and techniques for effective quality audit reports.
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Level 2 Behaviors
(Light Experience)
Assists in internal audits to determine compliance with quality management system standards.
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Level 3 Behaviors
(Moderate Experience)
Administers both product and process audits to quality standards throughout all stages of the manufacturing process.
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Level 4 Behaviors
(Extensive Experience)
Delivers strategic recommendations to improve the quality of overall operations based on audit observations.
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Level 5 Behaviors
(Mastery)
Builds a self-audit program for our business to drive quality system and process improvements.
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3
Claims Quality Audit Manager
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Claims Quality Audit Manager
Proficiency Level - 4
5
Competency for -
Claims Quality Audit Manager
Proficiency Level - 5
11 soft skills or competencies (core competencies) for Claims Quality Audit Manager
1
Core Competencies –
Standard Operating Procedures (SOP)
Proficiency Level -3
Level 1 Behaviors
(General Familiarity)
Cites examples of SOP practices in our business operations.
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Level 2 Behaviors
(Light Experience)
Assists in the preparation of internal standard operating procedures (SOP).
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Level 3 Behaviors
(Moderate Experience)
Analyses our business and operations to identify room for improvement on the related standard operating procedures.
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Level 4 Behaviors
(Extensive Experience)
Coaches others on the implementation of SOP to reduce errors and improve quality.
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Level 5 Behaviors
(Mastery)
Builds a monitoring system to evaluate the effectiveness of our SOPs.
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2
Core Competencies –
Budgeting
Proficiency Level -2
Level 1 Behaviors
(General Familiarity)
Compiles a list of basic issues and risks for conducting our budget processes.
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Level 2 Behaviors
(Light Experience)
Applies established guidelines for conducting our budgeting processes.
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Level 3 Behaviors
(Moderate Experience)
Communicates budget objectives and plans to help identify financial trends and create budget forecasts.
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Level 4 Behaviors
(Extensive Experience)
Anticipates organizational income and expenses to make forecasts and develop budget plans.
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Level 5 Behaviors
(Mastery)
Adapts relevant industry trends on techniques in financial budgeting in our organization.
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3
Claims Quality Audit Manager
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Claims Quality Audit Manager
Proficiency Level - 4
5
Competency for -
Claims Quality Audit Manager
Proficiency Level - 5
Summary of Claims Quality Audit Manager skills and competencies
There are 7 hard skills for Claims Quality Audit Manager, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
1 general skills for Claims Quality Audit Manager, Quality Audit.
11 soft skills for Claims Quality Audit Manager, Standard Operating Procedures (SOP), Budgeting, Quality Management, etc.
While the list totals 19 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Claims Quality Audit Manager, he or she needs to be skilled in Standard Operating Procedures (SOP), be proficient in Budgeting, and be skilled in Quality Management.
1 general skills for Claims Quality Audit Manager, Quality Audit.
11 soft skills for Claims Quality Audit Manager, Standard Operating Procedures (SOP), Budgeting, Quality Management, etc.
While the list totals 19 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Claims Quality Audit Manager, he or she needs to be skilled in Standard Operating Procedures (SOP), be proficient in Budgeting, and be skilled in Quality Management.
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