Claims Quality Assurance Auditor

Pieinsurance

United States, United States
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Claims handling processes
Regulatory standards
Internal guidelines
** Pie Insurance is seeking a Senior Claims Quality Assurance Auditor responsible for conducting audits of claims handling processes to ensure compliance with industry standards and internal guidelines. The ideal candidate will have extensive experience in workers' compensation claims and quality assurance, with a focus on continuous improvement and collaboration across departments. **

Job Summary

  • The Senior Claims Quality Assurance Auditor will conduct regular audits and assessments of Pie's claims handling processes to ensure adherence to Claims Best Practices, regulatory standards, and internal guidelines.
  • This role is responsible for reviewing claim files for compliance, identifying areas of non-compliance, and recommending corrective actions to improve claims quality.
  • The auditor will collaborate with Claims teams, prepare detailed audit reports, and support the development of quality control policies and training programs that drive continuous improvement in claims performance and ensure regulatory compliance.

Matching Summary

Match Score: 75

** Pie Insurance is seeking a Senior Claims Quality Assurance Auditor responsible for conducting audits of claims handling processes to ensure compliance with industry standards and internal guidelines. The ideal candidate will have extensive experience in workers' compensation claims and quality assurance, with a focus on continuous improvement and collaboration across departments. **

Skills & Requirements

Must-have

  • claims handling processes
  • regulatory standards
  • internal guidelines
  • claims best practices
  • audit methodologies
  • claims management systems

Nice-to-have

  • continuous improvement
  • operational efficiency
  • win-win solutions
  • curiosity and tenacity
  • flexibility and adaptability

Key Requirements

  • High School diploma or GED required
  • Bachelor's degree preferred
  • Minimum 8 years of workers' compensation claims experience
  • 3+ years of experience in claims auditing, quality assurance, or compliance roles preferred
  • Strong knowledge of Claims Best Practices and regulatory requirements

Work Rights

Not specified

Tailored Resume

Cover Letter