Quality Officer

Job Description

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.
Sound like you Then read on.

About the Role
– The Quality Associate is accountable for the highest level of accuracy before a claim is paid-out to the insured. The role drives the discipline in balancing customer turnaround times and quality in all transactions processed through coaching and driving team initiatives to improve accuracy.
– The role ensures that claims are paid accurately to the correct claimant (insured and beneficiary), for the right amount and according to the provisions of the policy. The Quality Associate then ensures disbursements are accurate before uploading for final approval.
– Ensures that the claims assessed by the makers are aligned with the provisions and standard processing of claims. This includes analysis of the correct amount and the correct claimants.
– Checking is based on the Claims QA Checklist. The checklist includes the following:
– Checks the appropriate tools against the submitted documents
– Ensures the critical information is entered correctly
– Ensures the insured and beneficiaries are paid based on the insurance policy coverage and provisions of the contract
– Checked items is the basis of the Assessor’s monthly Quality Goal of 98% which constitutes 35% of the Assessors PDD
– Sends back the claim item to the assessor if any changes or corrections need to be done
– Delivers coaching to assessors using a coaching form and follows through on action plans agreed on during the coaching session
– Provides performance management recommendations to Claims manager based on the coaching sessions conducted
– Comes-up with error trending and initiatives to improve quality scores. Facilitates regular calibration meeting with the team.
– Serves as the team’s Subject Matter Expert
– Ensures that claim has been properly booked prior to pay-out
– Endorses the claim for disbursement

– When assigned as a JETT Maker: Ensures timely processing of Claims benefit pay-out by creating disbursements files, uploading on the system and assessing flags and taking appropriate actions.
– When assigned as a JETT Checker: Ensures disbursement file for upload are accurate by doing 100% QA of all the items for upload
– Provides list of the batches that were uploaded for reference of the checkers and approvers. Able to prepare requests immediately as needed.
– Process BAU related request (e.g: fallouts, reprocessing of rejected request, cancel and replacement, etc.)
– Prepare quality reports and provide insights on error trending and action
reduce errors

Work closely with Claims Manager to manage performance of Assessors
Coach assessor based on the error findings