Senior Claims Quality Assurance Auditor
Pie Insurance · Remote · United States · $90k–$115k
Posted by Pie Insurance on their careers site · View the original posting
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The posting, as Pie Insurance wrote it
Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance.
Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make.
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.
How You'll Do It
Claims Audit & Assessment
- 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 to address deficiencies
- Apply established audit methodologies and sampling techniques to ensure comprehensive evaluations
Documentation & Reporting
- Document audit findings with clear, detailed explanations of deficiencies and best practices observed
- Prepare comprehensive audit reports for management that include findings, recommendations, and action items
- Analyze data to identify trends, patterns, and areas for improvement across the claims organization
- Provide timely feedback to adjusters and Claims leadership on audit results
- Maintain accurate records of all audits, findings, and corrective action plans
Quality Control & Process Development
- Collaborate with various departments to ensure quality standards are met consistently
- Develop and update quality control policies and procedures based on audit findings and regulatory changes
- Assist in developing quality assurance goals and objectives aligned with department strategies
- Recommend process improvements to enhance claims quality and operational efficiency
- Support the implementation of new quality standards and best practices
Compliance & Corrective Action Monitoring
- Monitor the implementation and effectiveness of corrective and preventive actions
- Track remediation efforts to ensure deficiencies are addressed in a timely manner
- Verify that corrective actions result in sustained improvements in claims quality
- Coordinate
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are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process.
Base Compensation Range
$90,000 — $115,000 USD
Compensation & Benefits
- Competitive cash compensation
- Comprehensive health plans
- Generous PTO
- Future focused 401k match
- Generous parental and caregiver leave
- Our core values are more than just a poster on the wall; they’re tangibly reflected in our work
Making every part of working with us "Easy as Pie" - including our offer process. When we find someone we'd like as a Pie-oneer (a member of our team), we move quickly to put together a fair offer based on your skills, experience, location, and compensation expectations.
Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members.
Location Information
Unless otherwise specified, this role is remote. Remote team members must live and work in the United States ( territories excluded ) and have access to reliable, high-speed internet.
Additional Information
Pie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic.
Pie Insurance participates in the E-Verify program. Please click here , here and here for more information.
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Safety First: Pie Insurance is committed to your security during the recruitment process. We will never ask you for credit card information or ask you to purchase any equipment during our interview or onboarding process.