Senior Claims Quality Analyst

Summary:

The Quality Improvement job family serves the claims operation in a variety of capacities, most of which are carried out through specialized, technicalexpertise. The primary functions of this job family arecomprisedof quality claim audits and quality assurance tomaintainclaims guidelines, consistent processes, level of quality, etc., of internal staff and external vendors. These jobs may also perform estimate reviews and/or do full reinspection. In other cases, these jobs maybe responsible forassistinganalyst,specialist, the department, and/or other high-level positions that handle operational functions of the business area. Other key functions of the Quality Improvement job family may be improving process and procedures whilemaintainingtechnical bulletins, procedures, policies, practices, guidelines, and official records for the business area.

This is a 100%in-office position. Candidates must be able to work on-site at a designated company office during standard business hours.

Essential Responsibilities:

• Conduct and document claim audits in the designated audit system within established timelines, completing a minimum of three claim file audits per day.

• Evaluate claim files for coverage, liability, estimates, reserving, documentation, and compliance with internal standards, regulatory requirements, and quality expectations.

• Review property estimates for accuracy, completeness, and adherence to guidelines, and identify potential leakage or missed cost controls.

• Analyze audit results and perform focused audits on specific trends as needed to identify gaps and opportunities for improvement.

• Provide clear and constructive feedback to claims staff and leadership.

• Escalate critical findings and provide immediate feedback to leadership when urgent action is needed on a claim.

• Participate in internal calibration activities within the Quality team to ensure scoring consistency.

• Partner with leadership to support training initiatives and process improvements.

Required Qualifications:

• Bachelor’s degree in a related field

• Field claims experience with property inspections and estimate preparation

• Experience handling liability claims

• Familiarity with Guidewire and Athenium auditing platforms