Quality Analyst - Leave & Disability Claims
Core
Evaluating the quality, accuracy, consistency, and compliance of leave and short-term disability claim administration through audits and feedback.
Role type
Quality Analyst (Claims & Compliance)
Builds
Operational readiness, process improvements, and regulatory compliance for leave and disability products.
Domain
Financial services / Insurance / Claims administration
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
claim adjudication processes, regulatory interpretation, audit execution, trend analysis, root cause analysis, process improvement, system testing support, multi-priority management
Preferred skills
audit or quality review experience, FMLA/ADA/STD/PFML/state leave regulations knowledge, FINEOS claim system proficiency
Technologies
FINEOS
Responsibilities
Conduct comprehensive audits of leave, short-term disability, accommodation, and related claim files; Review claim documentation, correspondence, decisions, and system entries for accuracy and completeness; Partner with QA Consultants and QA Manager to analyze audit findings to identify trends, root causes, and emerging operational risks; Collaborate with Operational Readiness, Training, and Operations leadership to improve processes and procedures; Support projects or system testing efforts designed to improve operational efficiency, accuracy, and customer outcomes; Manage claims or quality-related work as needed to support service delivery objectives
Seniority
Mid-level, hands-on IC