Quality Assurance, Risk Control & Special Investigations Analyst
Core
Ensures operational integrity, service excellence, and regulatory adherence across life insurance Third-Party Administrator (TPA) operations through auditing, fraud investigation, and risk monitoring.
Role type
Quality Assurance, Risk Control & Special Investigations Analyst
Builds
Operational integrity and fraud mitigation within TPA processing environments
Domain
Life Insurance / Financial Services / TPA Operations
Deliverable
dashboards & analysis | client delivery
Required skills
Quality Assurance auditing, Fraud analysis, Life insurance policy lifecycle knowledge, TPA operating procedures, Transaction history analysis, Regulatory compliance monitoring, Internal control auditing, Process improvement
Preferred skills
Quality monitoring system experience, State/federal insurance regulations knowledge, SOX/SOC audit experience, QA checklist creation
Responsibilities
Conduct comprehensive quality audits of inbound and outbound call center interactions, Review and audit completed service and administrative forms for accuracy, Deliver feedback and coaching to call center agents and team leads, Track and analyze TPA and QA metrics to identify root causes, Review and analyze pre-referral fraud cases and claims, Collect and summarize documentation for suspicious activity, Execute periodic monitoring of operational and financial controls, Collaborate with Operations and Training teams to develop process changes and training modules
Seniority
Mid-level, hands-on IC
