QA & Compliance Senior Specialist

Specialty Claims Quality Assurance And Compliance Senior Specialist

We are seeking a detail-oriented and analytical individual to join our team as a Specialty Claims Quality Assurance and Compliance Senior Specialist. This role will report to the VP, Specialty Claims Compliance and will be responsible for supporting Specialty Claims through quality assurance, compliance oversight, claims governance, and operational reporting activities. You will help ensure claims are handled in accordance with regulatory requirements, internal quality standards, and industry best practices while coordinating key governance processes, including reinsurance reporting, large loss reporting, licensing compliance, and other critical reporting obligations.

The ideal candidate will possess strong analytical skills, attention to detail, and a comprehensive understanding of Specialty insurance claims best practices, procedures, and compliance regulations.

Duties and Responsibilities:

• Perform quality reviews and audits across Specialty insurance claims to ensure accuracy, completeness, and compliance with internal standards, regulatory requirements, and best practices, with emphasis on higher-risk and more complex claim activity.
• Evaluate claim handling practices in high-risk and complex claim areas to identify trends, control gaps, and areas of elevated regulatory, litigation, or E&O exposure.
• Provide focused QA oversight for AI-enabled functionality used in claims, including reviewing outputs, identifying issues, and ensuring appropriate governance and controls are in place.
• Partner with Claims leadership, Compliance, and Operations to address QA findings, support corrective actions, and improve consistency in claim handling.
• Develop and deliver targeted training and guidance based on QA findings to reinforce expected claim handling practices and address recurring issues.
• Prepare clear, actionable QA reports summarizing findings, trends, and recommendations and claims reporting activities for Claims leadership.
• Monitor regulatory developments, industry trends, and emerging risks impacting Specialty claims and incorporate them into QA focus areas and training.
• Ensure internal claims staff meet applicable licensing requirements and support related tracking and documentation.
• Monitor reinsurance and large loss reporting processes to ensure timely and accurate internal/external reporting.

Qualifications:

• Seven or more years of experience in Specialty insurance claims handling, quality assurance, compliance, or a related role.
• Strong knowledge of Cyber, Financial Institutions, Management Liability, Professional Lines, and applicable state and federal insurance regulations.
• Demonstrated experience reviewing complex claims and identifying quality, compliance, or control issues.
• Ability to analyze claim data and QA results to identify patterns, trends, and areas of risk.
• Strong attention to detail and sound judgment when evaluating claim handling decisions.
• Working knowledge of claims systems and tools, including Guidewire ClaimCenter and related document management platforms.
• Clear written and verbal communication skills, with the ability to provide constructive feedback and partner effectively with claim professionals and leadership.
• Professional insurance or compliance designations preferred.
• Ability and willingness to travel as needed.