Senior Claims Quality Assurance Auditor

🔥 14 minutes ago

🇺🇸 United States – Remote

💵 $90k - $115k / year

⏰ Full Time

🟠 Senior

🔧 QA Engineer (Quality Assurance)

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Pie Insurance

WebsiteLinkedInAll Job Openings

201 - 500 employees

🛡️ Insurance

💳 Fintech

🤝 B2B

Insurance • Fintech • B2B

Pie Insurance is transforming small business insurance by making it less expensive, simpler, and more transparent for small business owners. With a team of seasoned technology and insurance experts, Pie Insurance is dedicated to enhancing the insurance experience, particularly focused on workers' compensation and InsureTech innovations.

📋 Description

• Conduct regular audits and assessments of quality management systems and claims handling processes • Review claim files for compliance with regulatory standards, statutory requirements, and internal guidelines • Evaluate claims for adherence to Claims Best Practices and quality standards • Assess claim documentation, investigation techniques, reserve adequacy, and settlement practices • Identify non-compliance and recommend corrective actions • Apply audit methodologies and sampling techniques • Document audit findings and prepare comprehensive reports for management • Analyze data to identify trends, patterns, and improvement areas • Provide feedback to adjusters and Claims leadership • Maintain records of audits, findings, and corrective action plans • Develop and update quality control policies and procedures • Recommend process improvements and support new quality standards • Monitor corrective and preventive actions and track remediation efforts • Coordinate with external auditors when needed • Stay current with regulatory changes and industry best practices • Train staff and coach adjusters on quality assurance, claim handling, and compliance • Develop targeted training based on audit findings • Partner with Claims Adjudication, Regulatory Compliance, Learning & Development, and Data & Analytics teams • Communicate quality trends and recommended actions to Claims leadership

🎯 Requirements

• High School diploma or GED required; Bachelor's degree in Business Administration, Risk Management, or related field preferred • 8+ years of workers' compensation claims experience • 3+ years of experience in claims auditing, quality assurance, or compliance roles preferred • Minimum of 2 years of California workers' compensation claims experience required • Strong knowledge of Claims Best Practices and regulatory requirements across multiple jurisdictions • Experience conducting claim file reviews and documenting audit findings • Must live and work in the United States, territories excluded • Access to reliable, high-speed internet

🏖️ Benefits

• Competitive cash compensation • Comprehensive health plans • Generous PTO • Future focused 401k match • Generous parental and caregiver leave • Discretionary bonuses may be granted to eligible team members • Core values tangibly reflected in the work

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