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Protocol Intelligence
Data-driven signals on your job's competitivenessTier-1 brand, mid-level generalist role, metro location, and broad skills increase applicant competition.
Claims and reserve expertise are industry-specific, limiting cross-industry transferability.
Explicit 5–7 years plus domain-specific claims experience makes shortlisting strict and selective.
Job Description
Structured overview of role & requirementsAbout This Role
Conduct quality claim reviews to identify trends, risks, and reserve adequacy insights, translating findings into actionable themes.
Partner with claims leadership and stakeholders to communicate quality results and support operational improvement initiatives.
Lead end-to-end quality review processes including planning, file selection, execution oversight, reporting, and development of workflows and dashboards to enhance review effectiveness.
Minimum Requirements
Bachelor's degree required; MBA or advanced degree preferred.
5–7 years of experience in claims processing or insurance operations with knowledge of claims handling practices.
Experience working in carrier and/or third-party administrator (TPA) environments.
Proficiency in Microsoft Office tools and data-driven reporting.
Ideal Candidate Profile
Experienced in claims quality assurance and continuous improvement within insurance or claims services.
Skilled in cross-functional collaboration with claims leadership, underwriting, actuarial, internal audit, and third-party administrators to improve claim quality and operational outcomes.
Capable of managing end-to-end review process with strong analytical skills and attention to regulatory compliance and governance.