Claims Quality Assurance Auditor at Jobgether – United States

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.

• 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