California FAIR Plan Association

• Spearhead analysis for large and complex initiatives impacting insurance billing, payments, commissions, collections, and financial integrations • Drive end-to-end requirement lifecycle, including discovery, documentation, validation, and solution alignment for enterprise billing capabilities. • Facilitate cross-functional workshops with Billing, Finance, Product, Operations, and IT stakeholders to define and align business and system requirements. • Perform cross-system impact analysis across billing and related enterprise systems to ensure solution consistency and alignment. • Define solution approaches with architects, engineering leaders, and stakeholders. • Influence enterprise roadmap planning and contribute to billing system capability and modernization decisions. • Establish and promote analysis standards, documentation practices, and best practices across initiatives. • Provide strategic recommendations for process, system, and operational improvements in billing. • Direct complex UAT planning and execution, including coordination of defect resolution and business sign-off • Mentor and guide Business Analysts, providing functional leadership and strengthening team capability. • Act as the functional lead and trusted advisor for billing-related initiatives and decision-making discussions. • Collaborate closely with IT delivery teams, QA, and business stakeholders, ensuring successful solution delivery and adoption. • Ensure compliance with federal, state, and industry regulations impacting insurance billing. • Perform other duties as required to support organizational objectives and the successful delivery of billing initiatives.

• Design, develop, and deliver application features, enhancements, and defect fixes including development and configuration within the Duck Creek platform. • Write clean, maintainable, and efficient code aligned with established coding standards and best practices. • Perform root cause analysis and resolve moderately complex defects, system issues, and performance challenges. • Participate in technical design discussions and contribute to solution design and implementation approaches. • Collaborate cross-functionally with Business Analysts, QA, DevOps, and product teams to ensure successful delivery. • Conduct peer code reviews and uphold coding standards, quality, and consistency across the codebase. • Support application deployments, release activities, and environment troubleshooting. • Work within CI/CD pipelines and contribute to improving build, deployment, and release processes. • Identify opportunities for code optimization, performance improvements, and system enhancements. • Analyze system workflows and integrations to ensure alignment with business and technical requirements. • Own assigned features from development through testing and deployment support. • Guide and support junior developers and contribute to team knowledge sharing. • Follow and continuously improve development processes, standards, and engineering best practices

• Continually evaluate Claims processes for efficiency and regulatory compliance. • Lead and coach staff to elevate performance, foster development, and ensure accountability. • Monitor, measure, and report on process improvements and training effectiveness. • Coordinate legal review of training material and document approvals in compliance records. • Guide and oversee the Claims Business Process Analyst, ensuring efficient collaboration with business partners. • Oversee the claims data reporting process, ensuring timely, accurate data reporting. Monitor new regulations and industry practices for CFP policy updates. • Ensure all Department of Insurance compliance training materials are up to date, keeping pace with regulatory changes and other market developments. • Oversee the creation of Claims unit training materials, delivery methods, and employee development programs to align with unit and company strategy and standards. • Implement policies to ensure compliance with claim-handling guidelines and to ensure good-faith handling of claims. • Collaborate with Claims Managers to provide relevant content for training materials. • Identify and recommend specific training programs to help employees maintain or improve job skills. • Recommend process modifications to improve quality, workflow, and policies and procedures. • Develop and manage the Claims training schedule for new hires, current team members, and vendors. • Report implementation progress and training completion to Claims management. • Serve as the liaison to the California Earthquake Authority, representing the organization with professionalism and integrity. • Any other duties needed to fulfill the Association's Mission, Values, and Strategic Objectives.

• Manage and oversee the Product function and serve as the primary decision maker, ensuring compliance. • Manage, coach and train Product team. Oversee hiring, counseling, and performance appraisals. • Conduct Staffing Analysis based on Product workload. • Coordinate with the Product team to integrate changes in policies, coverage or other underwriting rules. • Assist in the annual budget preparation and analysis. • Oversee research, analysis, and testing of product changes, roll outs, and channel enhancements. • Oversee Underwriting Rate and Rule manuals, policy forms, Dec pages, disclosures, applications and notices. • Collaborate with actuarial staff to prepare state rate, rule and form filings and respond to state insurance department inquiries. • Oversee research and analysis to provide product and guideline recommendations. • Facilitate ad-hoc analysis on specified or varied metrics. • Analyze metrics regarding Underwriting practices and recommend efficiencies in work processes and vendor/internal tools. • Create presentations to support rate changes and other strategic decisions. • Lead and collaborate with other departments, to improve underwriting processes and performance results. • Ensure timely and accurate application of all underwriting, premium, and policy compliance guidelines and processes supported by meaningful measurements and regular reporting of results. • Performs additional duties and/or special projects as required.

• The Claims Quality Assurance Supervisor leads a team of Quality Assurance Representatives or Quality Analysts. • Responsible for reviewing claim files for accuracy, compliance with policies and procedures, as well as CA Department of Insurance guidelines. • Managing communications with the Department of Insurance. • Assisting with coverage analysis for Claims Examiners. • Collaborating with and support Claims Quality Analysts and QA Representative teams to maintain the daily workflow across the Quality Assurance Department. • Hire, train, and coach Quality Assurance Representatives and Claims Quality Analysts. • Provide file data for file reviews and maintain the audit platform. • Direct and oversee file reviews and Department of Insurance complaint responses. • Provide feedback/results/trends to Claims Examiners based on review results and findings. • Review, analyze, and provide suggestions for claim handling practices. • Compile estimate revision requests and coordinate with network contractors to obtain estimate corrections. • Verify file documentation is included for completion of the review process. • Create and maintain workbooks, questionnaires, processes, and training materials to promote accuracy and consistency. • Take lead on various projects, including but not limited to QA software and report implementation. • Manage CEA Liaisons and support CEA training and reporting. • Adhere to Federal and State laws and regulation. • Any other duties needed to help fulfill the Associations Mission, abide by the Association’s Values, and fulfill the Association’s Strategic Objectives.

• Propose high-impact projects that drive the Association’s long-term goals • Lead the development and publishing of business requirements, value propositions and measurement development during the pre-project submission and proposal development phases • Provide follow-through and due diligence during the project submission, evaluation and development project phases, supporting the project manager and associated business and IT stakeholders. • Foster cross functional collaborations and ensure stakeholders are held accountable. • Define and manage proposal scope and boundaries, proactively identifying and resolving conflicts/ risks. • Ensure alignment to Association’s goals within the compliance framework • Advise and support project, business, and IT owners throughout the proposal life cycle. • Supervise analysts as assigned.

• Assist underwriters in reviewing property insurance applications and supporting documentation • Perform risk analysis using internal tools, guidelines, and third-party data sources • Participate in file audits, underwriting meetings, and training sessions • Support team with data entry, document management, and administrative tasks • Collaborate on special projects or presentations related to underwriting strategies

• Develop reports (and product dashboards) necessary to monitor the FAIR Plan’s profitability, efficiency, growth of new products/enhancements. • Collaborate with actuarial staff to prepare state rate filings and respond to state insurance department inquiries. • Support research, analysis, and testing of product changes, roll outs, and channel enhancements, including maintenance of Rate and Rule manuals. • Query databases to conduct ad-hoc analysis on specified or varied metrics. • Analyze metrics regarding Underwriting practices and recommend efficiencies in work processes and vendor/internal tools. • Identify trends and recommend product enhancements. Use data to identify efficient investigation of risk practices. • Prepare presentations in support of rate changes and other strategic decisions. • Use knowledge of state regulatory guidelines and constraints to assure product compliance. • Lead project efforts, collaborating with other departments, to explore business problems, resulting in improvements to underwriting processes and performance results. • Generate insights that equip decision makers with knowledge to optimize business performance. • Perform additional duties and/or special projects as required.

• Evaluate operations business processes and identify opportunities to enhance efficiency, accuracy, and customer satisfaction. • Identify operational gaps, data inconsistencies, and process bottlenecks. • Document workflows using process mapping and related methodologies. • Collaborate with business stakeholders, to design improved end-to-end processes. • Translate business needs into functional process requirements for automation, system enhancement, and workflow redesign. • Develop, standardize, and maintain operations-related business processes, procedures, and performance metrics. • Collaborate with other departments to ensure process coherence, data alignment, and to enhance system capabilities. Support Single Source of Truth initiatives ensuring consistent data usage, definitions, and reporting across systems. • Define and track key performance indicators (KPIs) to measure process effectiveness and turnaround times. • Prepare and present insights, findings, and process improvement recommendations to leadership. • Support internal and external audits with accurate process documentation and data integrity assurance. • Lead or participate in business process reengineering (BPR) and operational efficiency initiatives. • Create feedback loops, metrics-driven decision making, and proactive issue resolution. • Perform any other tasks required to support the Association’s Mission, Values, and Strategic Objectives.

• Manage a caseload of commercial property claims from assignment through resolution. • Examine commercial claims investigated by independent adjusters to determine the extent of insurance coverage and validity of the claims. • Review and adjust commercial loss reserves, correspondence, reports, verify coverage and authorize payments submitted by independent adjusters. • Collaborate with internal personnel and/or legal counsel on claims involving litigation. • Investigate, evaluate, and adjust claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims. • Oversee independent adjuster files to ensure they have followed CFP IA Guidelines. • Verify and analyze data used in settling claims to ensure validity and that settlement is in accordance with company practices and procedures. • Maintain compliance with the Department of Insurance and Company procedures. • Identify fraud or illegal activity indicators and follow internal processes to refer the claims to the appropriate personnel for follow up. • Promptly negotiates settlements ensuring the settlement reflects the insured losses while confirming the insurer is protected from invalid claims.