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 key to ensuring excellence in claims management by auditing, assessing, and improving claims processes across the organization. The Claims Quality Assurance Auditor will monitor compliance with regulatory standards, internal policies, and best practices while identifying areas for operational improvement. You will collaborate closely with claims teams, leadership, and cross-functional departments to implement quality control measures and support training initiatives. This position combines analytical rigor with hands-on process improvement, offering an opportunity to impact the consistency, efficiency, and accuracy of claims operations. The role is ideal for someone passionate about maintaining high standards, driving measurable improvements, and shaping the claims experience for both customers and internal stakeholders.

Accountabilities:

Conduct monthly and quarterly audits of claims files to verify compliance with regulatory standards, internal guidelines, and claims best practices
Evaluate documentation, investigation techniques, reserve adequacy, and settlement practices to ensure quality and consistency
Apply scoring methodologies to measure compliance performance and identify systemic risks
Document audit findings, prepare comprehensive reports with recommendations, and communicate trends to leadership
Support development of quality control policies, procedures, and training programs to drive continuous improvement
Monitor the implementation and effectiveness of corrective actions and remediation efforts
Collaborate with cross-functional teams including Claims, Learning & Development, and Regulatory Compliance to ensure high-quality outcomes

Requirements:

High School diploma or GED required; Bachelor’s degree in Business Administration, Risk Management, or related field preferred
5+ years of experience in workers’ compensation or commercial claims handling with strong understanding of claim practices
2+ years in auditing, quality assurance, or compliance roles preferred
Knowledge of claims best practices and regulatory requirements across multiple jurisdictions
Experience reviewing claims files and documenting findings with clear, actionable recommendations
Strong analytical, communication, and organizational skills
Ability to collaborate with teams, train staff, and influence process improvements

Benefits:

Competitive base salary ($75,000 – $95,000 USD) with potential discretionary bonuses
Equity participation opportunities
Comprehensive health, dental, and vision plans
Generous paid time off and flexible vacation policies
401(k) with employer match
Parental and caregiver leave
Remote work flexibility with reliable high-speed internet access

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

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