Sr Insurance Operations Quality Assurance Specialist

53 minutes ago
Full-time
Senior
Quality Assurance and Testing
Horace Mann

Horace Mann

Horace Mann is the largest financial services company dedicated to helping educators and community servants achieve lifelong financial success. They offer a full range of tailored insurance and financial products, including auto, home, and life insuran...

Insurance
1K-5K
Founded 1945

Description

  • Conduct daily, ad hoc, and special quality audits across Claims, Customer Service, New Business, Underwriting, and Policy Services.
  • Evaluate work for accuracy, completeness, policy compliance, and regulatory adherence.
  • Audit complex, high-risk, and non-routine Supplemental Health claims from initial review through final disposition.
  • Interpret policy provisions, benefit requirements, limitations, exclusions, and plan language when assessing claim decisions.
  • Analyze documentation and multiple information sources to identify inconsistencies and unsupported decisions.
  • Document audit findings in quality databases and provide feedback to operational leadership.
  • Identify processing errors, trends, root causes, and opportunities for operational improvement.
  • Recommend corrective actions and process improvements to strengthen quality and customer outcomes.
  • Help develop and refine quality audit programs and procedures for new products, systems, and services.
  • Support auditor training, coaching, calibration exercises, and technical guidance.

Requirements

  • High school diploma or GED.
  • 3+ years of health claims experience.
  • Strong understanding of claims workflows and Supplemental Health claim administration.
  • Ability to interpret policy provisions, benefits, limitations, exclusions, and plan language.
  • Exceptional attention to detail with strong analytical and critical-thinking skills.
  • Ability to evaluate complex information and exercise sound judgment.
  • Strong written and verbal communication skills.
  • Previous Quality Audit or Quality Assurance experience preferred.
  • Experience auditing complex Supplemental Health claims preferred.
  • Experience providing technical guidance, training, or calibration support preferred.

Benefits

  • Annual salary of $57,500–$71,900, plus bonus.
  • Salary commensurate with experience and location.
  • Special insurance rates and benefits for educators.

Interested in this position?

Apply directly on the company website

Apply Now

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