Quality Assurance & Compliance Specialist

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Quality Assurance & Compliance Specialist Full-time Regular Technical 6 days ago Requisition ID: 1302 Salary Range: $85,000.00 To $110,000.00 Annually About the Role K2 Claims Services, LLC (“K2 Claims”) is seeking an experienced Quality Assurance & Compliance Specialist to expand and strengthen our established quality assurance program across the homeowners/personal property and liability claim teams. As a third-party administrator (TPA), K2 Claims services specialty programs across property, homeowners, general liability, auto, builder’s risk, professional liability, and workers’ compensation on behalf of a diverse group of carrier and program partners. This role builds on K2’s existing quality assurance program. The successful candidate will administer audit scorecards, conduct routine and targeted file reviews, report trends across teams and programs, and work with managers to strengthen claim handling, while serving as K2’s internal point of preparation for carrier, client, and regulatory audits. This is a highly visible, cross-functional position reporting to senior leadership in both the Personal Lines and Commercial/Liability organizations. It is an opportunity to take ownership of an existing program, shape where it goes next, and help a well-established, growing company continue building a world-class TPA. Key Responsibilities File Auditing & Quality Review Claim File Audits: Conduct scheduled and targeted audits of open and closed claim files across homeowners/personal property and general liability/casualty lines, measuring adherence to K2 Claims Best Practices, client-specific handling instructions, and applicable state regulations. Full Lifecycle Review: Evaluate the complete claim lifecycle including FNOL handling and contact timeliness, investigation quality, coverage analysis and documentation, reserve adequacy and supporting rationale, damage evaluation and estimating, negotiation and settlement, diary management, file note quality, payment accuracy, and proper closure. Coverage Correspondence: Verify that reservation of rights letters, coverage declinations, and other coverage correspondence are accurate, timely, professionally drafted, and cite the correct policy forms, endorsements, and exclusions. Litigation Management Review: Assess counsel referral timeliness, litigation plans and budgets, defense counsel oversight, documented settlement authority, mediation preparation, and large loss reporting to carriers and clients. Recovery & Referral Review: Confirm that subrogation, salvage, contribution, risk transfer, and Special Investigation Unit (SIU) opportunities are identified, referred, documented, and pursued. Objective Scoring: Score files against a standardized audit template, documenting exceptions with evidence-based findings tied to specific file entries so results are consistent, reproducible, and actionable across teams. Compliance & Regulatory Oversight Regulatory Adherence: Monitor compliance with state Fair Claims Settlement Practices and Unfair Claims Practices requirements, statutory acknowledgment, investigation, and decision deadlines, and state-specific notice, delay, and letter requirements. Statutory Reporting: Support compliance with Medicare Secondary Payer / Section 111 reporting obligations, lien resolution protocols, anti-fraud referral requirements, and privacy and data handling obligations governing claim files. Client & Carrier Standards: Maintain audit-ready documentation supporting K2’s obligations under client service agreements, program guidelines, and carrier claim handling standards, including contractually required reporting, service level commitments, and file documentation expectations. External Audit Coordination: Serve as the internal coordinator for carrier, client, regulatory, and market conduct audits — assembling file samples, preparing narrative responses, and tracking remediation of findings through closure. Reporting & Analytics Audit Reporting: Produce audit scorecards, exception summaries, trend reports, and dashboards for adjusters, managers, and senior leadership on a defined monthly and quarterly cadence. Root Cause Analysis: Analyze recurring exceptions to distinguish individual performance issues from systemic process, training, staffing, or claims system deficiencies. Corrective Action: Develop, track, and validate corrective action plans, and re-audit to confirm measurable improvement. Program-Level Insight: Provide leadership with quality metrics segmented by program, carrier, examiner, and claim type to support client reporting and service level commitments. Adjuster Coaching: Review audit results with individual adjusters in conjunction with their direct manager, in a constructive, coaching-oriented manner that reinforces standards without discouraging sound independent judgment. Calibration: Calibrate scoring methodology with managers and senior leadership so results are applied consistently across teams, programs, and lines of business. Training Input: Partner with claims managers and leadership to shape onboarding, training curriculum, and continuing education priorities driven by audit findings. Standards Development: Recommend and help draft updates to claim handling guidelines, best practices, letter and form templates, diary standards, and claims system configuration. Technical Resource: Participate in file reviews, roundtables, and large loss discussions as a quality and compliance subject matter resource. Qualifications Experience: 7+ years of property and casualty claims experience is ideal, with a minimum requirement of 5+ years handling both homeowners/personal property and general liability claims. Audit Background: Prior quality assurance, file audit, claims supervision, technical review, or compliance experience is strongly preferred. Technical Depth: Demonstrated command of policy interpretation and coverage analysis, reserving discipline, liability and damages evaluation, litigation management, and subrogation. Regulatory Knowledge: Working knowledge of state Fair Claims Settlement Practices regulations and statutory claim handling deadlines. California experience is preferred. Industry Background: Previous experience in a TPA, insurance carrier, MGA, or program administrator environment handling diverse programs. Exposure to excess and surplus lines, Lloyd’s syndicates, and/or delegated or binding authority structures is a significant plus. Licensing: Ability to obtain and maintain all required state adjuster licenses. A California adjuster’s license is preferred. Education: Bachelor’s Degree is preferred. Industry designations such as AIC, CPCU, SCLA, or AINS are preferred. Technical Proficiency: Advanced Microsoft Excel skills (pivot tables, lookups, and data summarization) along with Word and Outlook. Experience with claims management systems and standard reporting tools. Communication: Exceptional written and verbal communication skills, with the ability to deliver critical findings diplomatically and support conclusions with documented evidence. Judgment & Independence: Objective, detail-oriented, and comfortable working autonomously across multiple teams while reporting difficult findings candidly to senior leadership. Travel: Must be flexible for occasional business travel for audits, training, and client or carrier meetings. Why Join K2 Claims? Medical, dental, and vision coverage. Competitive base salary plus a bonus plan. 401(k) with employer match. Generous paid time off, available starting in your first year. A collaborative team environment within a growing company. High visibility with senior leadership and the opportunity to shape a growing quality assurance program. #J-18808-Ljbffr