Senior Claims Quality Assurance Auditor

The role

The Senior Claims Quality Assurance Auditor conducts regular audits and assessments of claims handling processes. This person reviews claim files for compliance, identifies non-compliance, and recommends corrective actions to improve quality and ensure regulatory adherence.

What you will do

• Conduct regular audits and assessments of quality management systems and claims handling processes
• Review claim files to verify compliance with regulatory standards, statutory requirements, and internal guidelines
• Evaluate claims for adherence to Pie's Claims Best Practices and quality standards
• Assess claim documentation, investigation techniques, reserve adequacy, and settlement practices
• Identify areas of non-compliance and recommend corrective actions
• Document audit findings with clear, detailed explanations
• Prepare comprehensive audit reports for management
• Analyze data to identify trends, patterns, and areas for improvement
• Develop and update quality control policies and procedures
• Train staff on quality assurance policies, procedures, and industry best practices

Required qualifications

• High School diploma or GED
• 8+ years of workers' compensation claims experience
• Minimum of 2 years of California workers' compensation claims experience
• Strong knowledge of Claims Best Practices and regulatory requirements across multiple jurisdictions
• Experience conducting claim file reviews and documenting audit findings

Nice to have

• Bachelor's degree in Business Administration, Risk Management, or related field
• 3+ years of experience in claims auditing, quality assurance, or compliance roles

Benefits

• Competitive cash compensation
• Comprehensive health plans
• Generous PTO
• Future focused 401k match
• Generous parental and caregiver leave

Before you apply

• Remote team members must live and work in the United States (territories excluded)
• Remote team members must have access to reliable, high-speed internet
• By submitting your application, you acknowledge and consent to Pie utilizing AI technologies to assist in our evaluation process

About the company

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. They leverage technology to transform how small businesses buy and experience commercial insurance.