Senior Manager, Quality Assurance and Audit, North America Claims, Claims Shared Services
Core
Lead, oversee, and optimize the North America claims audit program, including direct handle audits, TPA oversight, SIU, and fraud programs to ensure claim handling quality and compliance.
Role type
Senior Manager, Claims Quality Assurance and Audit
Builds
Audit programs, dashboards, scorecards, and management reports for Claims leadership
Domain
Specialty insurance and reinsurance claims
Deliverable
dashboards & analysis
Required skills
Claims audit program management, TPA oversight, SIU and fraud audit, technical claims judgment, audit analytics and reporting, compliance monitoring, stakeholder management, vendor management, remediation tracking
Preferred skills
Experience with commercial P&C insurance, reinsurance, specialty claims, operational risk
Technologies
None explicitly stated
Responsibilities
Lead and report on the North America claim handler audit program, TPA oversight audit program, and leadership quality control file review program; Manage end-to-end audit execution including planning, scope, scheduling, and sample selection; Develop dashboards, scorecards, and management reports covering quality review results and technical audit outcomes; Partner with Compliance, Legal, and Claims Leadership to align audit activity with regulatory and operational risk priorities; Enhance audit standards, questionnaires, scorecards, and methodologies in line with claim best practices; Assess SIU and fraud deliverables for timeliness, completeness, and consistency
Seniority
Senior Manager, hands-on leadership