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Job Description
• Perform end-to-end claim quality reviews and identify trends, risks, and operational gaps
• Analyze reserve adequacy and provide insights to claims leadership
• Prepare structured reports, dashboards, and quality metrics for decision-making
• Collaborate with cross-functional teams including actuarial, underwriting, audit, and TPAs
• Support development of workflows, quality frameworks, and training programs
• Ensure compliance with regulatory requirements and internal governance standards
• Lead planning, execution, and reporting of quality review processes
• Identify improvement opportunities and support continuous process optimization
• Maintain documentation and ensure audit readiness across claims operations
• Monitor operational performance and escalate critical issues when required