Job Description

Claims Quality Assurance Specialist - Property and Casualty Insurance - Base Salary to 100k/year - Great Neck, NY

• Our client, a large and growing insurance carrier, is seeking a Claims Quality Assurance Specialist who will work with departmental and team leaders to ensure claims operations comply with regulatory requirements, Fair Claims Settlement Practices, and industry best practices.
• In this role, the Claims Quality Assurance Specialist will conduct pre- and post-payment claims audits to ensure claim accuracy, regulatory compliance, and adherence to company policies. The Claims Quality Assurance Specialist will analyze claim trends, identify root causes, recommend process improvements, support operational reporting and KPI development, and collaborate on claims system enhancements and cross-functional initiatives to improve efficiency and strengthen claims operations.

Responsibilities:

• Conduct pre- and post-payment property and casualty claims audits to ensure claim accuracy, regulatory compliance, Fair Claims Settlement Practices, and adherence to company policies.
• Review claims adjudication processes to identify errors, overpayments, operational trends, and compliance issues.
• Perform root cause analysis and recommend improvements to claims processes, quality assurance standards, policies, procedures, and operational controls.
• Support business expansion by implementing claims operational processes and compliance frameworks for new jurisdictions.
• Develop, analyze, and report on claims quality metrics, operational KPIs, audit findings, and financial trends.
• Collaborate with IT teams, business stakeholders, and external vendors on claims system enhancements, reporting initiatives, workflow improvements, and operational projects.
• Support month-end operational activities and participate in cross-functional process improvement initiatives.

Qualifications:

• 5+ years of progressive experience in Property & Casualty (P&C) claims.
• Experience in claims auditing, claims quality assurance, claims compliance, or other compliance-focused claims roles.
• Experience reviewing claim accuracy, claims adjudication, operational compliance, and regulatory requirements.
• Experience performing root cause analysis and identifying process improvements within claims operations.
• Strong proficiency with Microsoft Excel and data analysis.

Compensation:

• Base salary in the 70k - 100k/year range
• Medical (PPO), dental (PPO), vision (PPO), and life insurance covered 100% for employees and 50% for dependents.
• 401k with 4% company match.
• Paid vacation, sick time, and 13 paid holidays.
• Hybrid Schedule after 90 days (3 Office Days / 2 Remote Days)

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