Claims Quality Assurance Auditor

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Claims Quality Assurance Auditor in United States.

This role is responsible for ensuring the integrity, compliance, and quality of claims processing across multiple jurisdictions. The Claims Quality Assurance Auditor will conduct audits, assess adherence to best practices and regulatory standards, and recommend corrective actions to continuously improve claims performance. You will collaborate with claims teams, analyze trends, prepare detailed reports, and support the development of scalable policies and training programs. The position offers a dynamic environment where you can directly influence operational excellence, risk mitigation, and customer satisfaction. You will work with cross-functional teams to implement improvements and foster a culture of compliance and continuous learning. This role provides the opportunity to shape quality assurance practices in a fast-evolving insurance landscape.

• Conduct monthly and quarterly audits of claims files and quality management systems to ensure compliance with regulatory standards, internal guidelines, and best practices
• Develop, refine, and execute audit programs, including weighted scoring, file sampling strategies, and performance benchmarks
• Document audit findings and provide detailed reports, including trends, deficiencies, and recommendations for corrective actions
• Collaborate with claims leadership to implement process improvements, quality control policies, and corrective action plans
• Partner with cross-functional teams including Learning & Development, Data & Analytics, and Regulatory Compliance to support training and quality initiatives
• Monitor the effectiveness of corrective and preventive actions to ensure sustained improvements in claims quality
• Share knowledge of claims handling, regulatory requirements, and best practices to enhance team capability

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Requirements:

• High school diploma or GED required; Bachelor’s degree in Business Administration, Risk Management, or related field preferred
• 5+ years of workers’ compensation claims experience with strong knowledge of claims handling practices
• 2+ years of experience in claims auditing, quality assurance, or compliance roles preferred
• Solid understanding of Claims Best Practices, regulatory requirements, and multi-jurisdictional compliance
• Proven experience conducting claim file reviews, documenting findings, and making actionable recommendations
• Strong analytical, detail-oriented, and problem-solving skills
• Excellent communication and collaboration skills to work effectively across teams

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Benefits:

• Competitive base salary ($75,000 - $95,000 USD)
• Equity opportunities to participate in company growth
• Comprehensive healthcare coverage
• Generous paid time off and parental/caregiver leave
• 401(k) plan with company match
• Remote work flexibility within the United States with high-speed internet support
• Opportunities to contribute to continuous improvement and quality-focused initiatives