7 hard skills or competencies (industry competencies) for Claims Quality Auditor I
Skill definition-Applying knowledge of the insurance industry to provide risk management services and protection to various individuals from financial loss.
Level 1 Behaviors
(General Familiarity)
Explains the policy conditions of various insurance contracts and products.
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Level 2 Behaviors
(Light Experience)
Provides prompt responses to clients’ insurance-related questions and concerns.
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Level 3 Behaviors
(Moderate Experience)
Reviews and analyzes claim applications to determine coverage eligibility and rates.
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Level 4 Behaviors
(Extensive Experience)
Monitors market trends in insurance services to deliver improved business impacts.
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Level 5 Behaviors
(Mastery)
Establishes and enforces standards for handling claims to maximize insurance workflow efficiency.
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Skill definition-Creating, executing, and adhering to state and federal laws governing insurance operations to ensure financial security and consumer protection.
Level 1 Behaviors
(General Familiarity)
Describes the importance of compliance programs in maintaining an insurance legal and regulatory environment.
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Level 2 Behaviors
(Light Experience)
Documents compliance complaints to track and escalate possible legal violations and ensure prompt resolution.
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Level 3 Behaviors
(Moderate Experience)
Executes market conduct exams to verify the adherence of insurance operations to laws and regulations.
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Level 4 Behaviors
(Extensive Experience)
Reviews root causes of regulatory deficiencies to create corrective action plans and ensure adherence.
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Level 5 Behaviors
(Mastery)
Develops an insurance regulatory framework to promote consumers' protection and achieve policy objectives.
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2 general skills or competencies (Job family competencies) for Claims Quality Auditor I
Skill definition-Verifying the adherence of product with required specifications and expectations to track and resolve deficiencies prior to product release.
Level 1 Behaviors
(General Familiarity)
Explains the step-by-step process of developing quality assurance plans.
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Level 2 Behaviors
(Light Experience)
Conducts quality assurance reviews related to surveys, licensing, and complaint investigations.
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Level 3 Behaviors
(Moderate Experience)
Manages the training of personnel in the correct interpretation of quality assurance protocols and processes.
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Level 4 Behaviors
(Extensive Experience)
Manages the refinement, management, and continuous growth of quality assurance capabilities.
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Level 5 Behaviors
(Mastery)
Establishes quality assurance program by developing and managing processes to identify and mitigate risks.
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Skill definition-Examining the conformance of a quality system to comply with standard specifications or procedures of the product, design, process, and system.
Level 1 Behaviors
(General Familiarity)
Identifies the basic quality audit functions and processes.
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Level 2 Behaviors
(Light Experience)
Conducts quality audits of the computerized maintenance tracking program to ensure accurate data entry updates.
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Level 3 Behaviors
(Moderate Experience)
Maintains evidence of quality conformance and ensures availability available for external audits.
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Level 4 Behaviors
(Extensive Experience)
Directs full-scope reviews of audit engagements to comply with internal audit methodology and quality standards.
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Level 5 Behaviors
(Mastery)
Conceptualizes quality management system (QMS) audit process to drive internal procedure and standard conformance.
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8 soft skills or competencies (core competencies) for Claims Quality Auditor I
Skill definition-A set of written instructions that describes the step-by-step activities to complete tasks in compliance with business standards and industry regulations.
Level 1 Behaviors
(General Familiarity)
Discusses the considerations and concerns on applying SOP for the first time.
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Level 2 Behaviors
(Light Experience)
Gathers information on workflows and business controlling points.
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Level 3 Behaviors
(Moderate Experience)
Initiates SOP revisions to support continuous improvement of processes.
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Level 4 Behaviors
(Extensive Experience)
Evaluates the benefits and drawbacks of a specific SOP; oversees the corresponding enhancements.
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Level 5 Behaviors
(Mastery)
Establishes formal policies and procedures to guide the our SOP practices.
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Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Identifies the procedures for making sure that results are mistake-free.
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Level 2 Behaviors
(Light Experience)
Records all appointments on the calendar to easily track daily activities.
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Level 3 Behaviors
(Moderate Experience)
Reviews and analyzes the accuracy of data and details.
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Level 4 Behaviors
(Extensive Experience)
Designs systems to help the team organize and track details and project progress.
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Level 5 Behaviors
(Mastery)
Develops best practices for identifying and correcting errors, oversights, and omissions.
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Summary of Claims Quality Auditor I skills and competencies
There are 7 hard skills for Claims Quality Auditor I, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
2 general skills for Claims Quality Auditor I, Quality Assurance, Quality Audit.
8 soft skills for Claims Quality Auditor I, Standard Operating Procedures (SOP), Attention to Detail, Honesty And Integrity, etc.
While the list totals 17 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 Auditor I, he or she needs to be proficient in Standard Operating Procedures (SOP), be proficient in Attention to Detail, and be proficient in Honesty And Integrity.