Senior Claims Quality Assurance Auditor
Core
Conduct regular audits and assessments of claims handling processes to ensure adherence to Claims Best Practices, regulatory standards, and internal guidelines.
Role type
Senior Claims Quality Assurance Auditor
Builds
Quality control policies, training programs, and audit reports for commercial insurance claims
Domain
Insurance (Workers' Compensation)
Deliverable
dashboards & analysis
Required skills
Claims auditing, regulatory compliance, audit reporting, process improvement, data analysis, training delivery, corrective action monitoring, cross-functional collaboration, claims adjudication knowledge, risk management
Preferred skills
Bachelor's degree in Business Administration or Risk Management, AI tool usage
Technologies
AI-powered application review tools, video interview tools
Responsibilities
Review claim files for compliance with regulatory standards and internal guidelines; Identify areas of non-compliance and recommend corrective actions; Prepare comprehensive audit reports for management; Train staff on quality assurance policies and industry best practices; Collaborate with Claims Adjudication and Regulatory Compliance teams; Monitor implementation of corrective and preventive actions
Seniority
Senior, hands-on IC