Claims Quality Assurance Auditor

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Claims Quality Assurance Auditor in United States.

This role is responsible for ensuring the integrity, compliance, and quality of claims processing across multiple jurisdictions. The Claims Quality Assurance Auditor will conduct audits, assess adherence to best practices and regulatory standards, and recommend corrective actions to continuously improve claims performance. You will collaborate with claims teams, analyze trends, prepare detailed reports, and support the development of scalable policies and training programs. The position offers a dynamic environment where you can directly influence operational excellence, risk mitigation, and customer satisfaction. You will work with cross-functional teams to implement improvements and foster a culture of compliance and continuous learning. This role provides the opportunity to shape quality assurance practices in a fast-evolving insurance landscape.

Accountabilities:

Conduct monthly and quarterly audits of claims files and quality management systems to ensure compliance with regulatory standards, internal guidelines, and best practices
Develop, refine, and execute audit programs, including weighted scoring, file sampling strategies, and performance benchmarks
Document audit findings and provide detailed reports, including trends, deficiencies, and recommendations for corrective actions
Collaborate with claims leadership to implement process improvements, quality control policies, and corrective action plans
Partner with cross-functional teams including Learning & Development, Data & Analytics, and Regulatory Compliance to support training and quality initiatives
Monitor the effectiveness of corrective and preventive actions to ensure sustained improvements in claims quality
Share knowledge of claims handling, regulatory requirements, and best practices to enhance team capability

Requirements:

High school diploma or GED required; Bachelor’s degree in Business Administration, Risk Management, or related field preferred
5+ years of workers’ compensation claims experience with strong knowledge of claims handling practices
2+ years of experience in claims auditing, quality assurance, or compliance roles preferred
Solid understanding of Claims Best Practices, regulatory requirements, and multi-jurisdictional compliance
Proven experience conducting claim file reviews, documenting findings, and making actionable recommendations
Strong analytical, detail-oriented, and problem-solving skills
Excellent communication and collaboration skills to work effectively across teams

Benefits:

Competitive base salary ($75,000 - $95,000 USD)
Equity opportunities to participate in company growth
Comprehensive healthcare coverage
Generous paid time off and parental/caregiver leave
401(k) plan with company match
Remote work flexibility within the United States with high-speed internet support
Opportunities to contribute to continuous improvement and quality-focused initiatives

Why Apply Through Jobgether?

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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Claims Quality Assurance Auditor

Requirements:

Benefits:

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