Quality Assurance Analyst

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Raphael & Associates

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1978

🛡️ Insurance

🏢 Enterprise

📋 Compliance

Insurance • Enterprise • Compliance

Raphael & Associates is a Third Party Administrator and Independent Claims Adjusting company internationally recognized for its exceptional service and unsurpassed reputation in nationwide claims handling. With a strong focus on property and casualty claims, the company provides comprehensive claims management, field adjusting, and loss control services tailored to meet the needs of various clients, including self-insured and public entities. Through strategic partnerships and regional offices across the country, Raphael & Associates is dedicated to maintaining high standards of service and leveraging technology to improve the claims process.

📋 Description

• Support the ongoing development, maintenance, and enhancement of the organization’s internal auditing platform, including identifying system improvements, testing updates, and optimizing audit workflows. • Conduct comprehensive audits of claim examiners to evaluate adherence to company policies, quality standards, and applicable regulatory requirements, while identifying areas of risk and opportunities for improvement. • Serve as a primary liaison between clients, third-party vendors, and internal stakeholders to coordinate external audit activities, ensuring timely communication and efficient audit execution. • Collect, review, organize, and submit audit-related documentation to support external audits, ensuring accuracy, completeness, and compliance with established requirements. • Collaborate with cross-functional teams to analyze operational processes, identify opportunities for increased efficiency and compliance, and assist in developing and documenting standardized procedures and best practices. • Partner with Training, Legal, and Human Resources departments on special projects, compliance initiatives, policy implementation efforts, and other organizational priorities to support regulatory and business objectives.

🎯 Requirements

• 10+ years of experience in claims, insurance, quality assurance, and client-facing roles, preferably within a Third-Party Administrator (TPA) environment. • Bachelor’s degree preferred; equivalent professional experience will be considered. • Advanced proficiency in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint). • Demonstrated experience with internal, client, and regulatory audits, including DOI complaint responses. • Working knowledge of licensing requirements, Medicare compliance, and other regulatory frameworks.

🏖️ Benefits

• Excellent Salary • Multiple Bonus Opportunities • Medical Benefits including Dental, Vision and Life • Paid Holidays/Vacation • 401(k) Plan • Flex-Time • Educational Assistance Program