Claims Quality Assurance Analyst

Job Description

Claims Quality Assurance Analyst

Job Summary

Seeking a highly skilled and detail-oriented Claims Quality Assurance Analyst to join a growing team. This role is integral to ensuring that the claims processes meet the highest standards of quality and compliance. The successful candidate will conduct regular quality reviews of claim files, analyze data, and provide actionable feedback to drive continuous improvement. This is a hybrid position requiring in-office presence two days per week, with the flexibility to work from home on other days.

Compensation Package

• Salary Range: $80,000 - $100,000 per year, plus performance-based bonus.
• Benefits Include:
• 401(k) with competitive company matching.
  

Responsibilities

• Conduct internal and Third-Party Administrator (TPA) claim quality assurance reviews in alignment with claims best practices and regulatory standards.
• Generate qualitative management information (MI) and analytical reports to identify trends, prioritize issues, and provide actionable insights.
• Review claim outcomes and resolutions, providing constructive feedback and recommendations for improvement, training, and remedial actions.
• Administer and oversee the ongoing monthly claim review process to ensure continuous evaluation of eligible file handlers.
• Plan and prioritize daily, weekly, and monthly workloads to meet output targets.
• Maintain accurate and detailed documentation in the appropriate systems.
• Collaborate with the Quality Assurance team and business units to drive continuous improvement and training initiatives.
• Serve as a point of contact for Quality Assurance queries, offering practical advice and guidance.
  
  

Qualifications/Requirements

• A minimum of 3 years of claims auditing experience or relevant background.
• 5-8 years of multi-line claims handling experience, preferably in General Liability, Professional Liability, and/or Property/Inland Marine lines of business.
• Strong written and verbal communication skills.
• Proven organizational and time management abilities.
• Comprehensive understanding of claims regulatory expectations and operational risk.
• Ability to adapt quickly to changing priorities and manage ad-hoc assignments effectively.
• Awareness of market trends, insurance compliance, risk, and regulatory issues.