Claims QA Specialist: Elevate Accuracy & Compliance

Pacific Life; Charlotte (NC); On-site; USD 97,423,872 - 111,750,912; Full time

Benefits offered by this job

Medical, Dental, Vision benefits

Wellbeing reimbursement account

Paid time off and holidays

Parental leave and adoption assistance

401k with company match

Job summary

Pacific Life is seeking an Operations Quality Assurance Specialist to join our Consumer Markets Division, with work in Omaha, NE or Charlotte, NC. You will conduct detailed audits of life insurance in-force processing, identifying trends and root causes to improve performance and reduce risk while strengthening service quality across the organization.

You will partner with claims leaders, processors, and trainers to clarify expectations, document findings, and drive corrective action.

Qualifications

• 1-4 years of experience in claims processing or QA.
• Strong analytical and critical thinking skills.
• Attention to detail and documentation accuracy.
• Ability to apply claims procedures with sound judgment in pay, setup, and follow-up reviews.
• Excellent communication and partnership skills for working with processors and leaders.
• Ability to manage multiple priorities in a fast-paced environment.
• Adaptability and learning agility.

Responsibilities

• Perform detailed quality audits of claims transactions across Pay QA, Set-Up QA, and Follow-Up QA, including claim payment accuracy and related processes.
• Evaluate claims processing for adherence to procedures, guidelines, controls, and regulatory requirements.
• Document QA findings with root cause, severity, and corrective actions.
• Partner with claims leaders, processors, trainers, and partners to clarify expectations and support corrective action planning.
• Analyze QA results to identify trends in payment errors and procedural gaps.
• Contribute to QA reporting and insights to inform leadership on risk areas and training needs.
• Support continuous improvement initiatives to increase quality and efficiency.
• Participate in calibration sessions to ensure consistent scoring across QA reviewers.

Skills

Claims processing

Quality assurance

Auditing

Compliance

Insurance operations

Financial operations

Operational risk

Job description

Pacific Life is seeking an Operations Quality Assurance Specialist to join our Consumer Markets Division, with work in Omaha, NE or Charlotte, NC. You will conduct detailed audits of life insurance in-force processing, identifying trends and root causes to improve performance and reduce risk while strengthening service quality across the organization.

You will partner with claims leaders, processors, and trainers to clarify expectations, document findings, and drive corrective action.