Claims Quality Assurance Manager

HINCX Hiscox Inc.; Chicago (IL); Hybrid; USD 100,000 - 130,000; Full time

Benefits offered by this job

Competitive salary and bonus

401(k) with company matching

Health insurance, vision and dental

Group term life and disability

Parental leave

Sabbatical after 5 years

Adoption assistance

Well-being programs

Modern open offices

Job summary

Hiscox USA is seeking a seasoned Quality Assurance Manager to lead the claims QA program across internal and third-party operations. You will own the QA framework, drive risk-based reviews, and report findings to senior leadership.

Collaborate with Claims Leadership, Compliance, Legal and Operations to ensure regulatory requirements and Hiscox Best Practices are applied, deliver sustainable improvements, and develop a high-performing QA team in a hybrid Chicago/Atlanta setting.

Qualifications

• 10+ years of progressive multi-line claims experience with QA, auditing, compliance, or risk responsibilities.
• Experience leading and developing a team within a quality assurance program.
• Deep knowledge of claims handling, regulatory expectations, state DOI standards, compliance, and risk.
• Ability to collaborate across internal and external teams, including third-party administrators.
• Proven ability to influence stakeholders and communicate clearly at all levels.
• Ability to translate complex findings into executive insights, risk assessments and actionable recommendations.
• Strong organizational skills and change leadership with a commercial, customer-focused approach.
• Track record of driving corrective action and reducing repeat quality deficiencies.

Responsibilities

• Set annual claims quality assurance strategy, plan, methodology, and risk-based priorities across internal and TPA claims operations.
• Lead, coach, and develop the Claims Quality Assurance team; set objectives and calibrate assessments.
• Own the quality assurance framework and governance standards in line with best practices and regulatory obligations.
• Oversee monthly and thematic claim reviews with coverage and evidence.
• Deliver concise management information and executive reporting on trends and risks.
• Present findings and recommendations to Claims Leadership and stakeholders with clear risk communication.
• Partner with leaders to implement corrective action plans and monitor delivery for sustainable improvement.
• Drive calibration, training, and continuous improvement based on reviews and regulatory developments.
• Maintain governance, documentation, issue escalation, and quality controls across the end-to-end review process.
• Serve as senior contact for claims QA matters and provide practical, commercially balanced advice.
• Monitor program effectiveness and adjust priorities, resources, and coverage as needed.

Skills

Quality assurance

Team leadership

Claims handling

Regulatory compliance

Stakeholder management

Data analysis

Job description

Job Type: Permanent Build a brilliant future with Hiscox Position: Quality Assurance Manager Business Unit/Function: Group Claims Location: Atlanta or Chicago Reporting to: Head of Claims Quality Assurance & Governance Type: Permanent – Full time

About the Team/Division: The Quality Assurance & Governance team is comprised of professionals with deep operational and technical expertise. This team is instrumental in driving claims quality assurance and governance across Hiscox, acting as a central reference for best practices and continuous improvement initiatives. Team members regularly engage with stakeholders throughout the company, promoting standardized processes, calibration, and ongoing development in claims handling. Adaptability is essential, as the team responds to the evolving needs of diverse stakeholders. As part of the Claims Quality Assurance Centre of Excellence, team members gain valuable exposure to a variety of insurance products and have opportunities to collaborate with business leaders across the organization.

The Role: The Claims Quality Assurance Manager leads the claims quality assurance program across internal and third-party administrator operations. This role is accountable for the quality framework, risk-based review strategy, team performance, stakeholder reporting, and delivery of sustainable improvements. The manager partners with Claims Leadership, Compliance, Legal, Operations, and business units to ensure regulatory requirements and Hiscox Claims Best Practices are consistently applied.

Key Responsibilities

• Set the annual claims quality assurance strategy, review plan, methodology, and risk-based priorities across internal and TPA claims operations.
• Lead, coach, and develop the Claims Quality Assurance team; establish objectives, allocate work, calibrate assessments, and maintain consistent, high-quality output.
• Own the quality assurance framework and governance standards, ensuring alignment with Hiscox Claims Best Practices, TPA Claim Handling Guidelines, regulatory obligations, and operational risk requirements.
• Oversee monthly and thematic claim reviews, ensuring appropriate coverage, timely completion, sound evidence, and defensible conclusions.
• Deliver concise management information and executive reporting that identifies trends, root causes, emerging risks, and priorities for corrective action.
• Present findings and recommendations to Claims Leadership and key stakeholders, clearly communicating risk, business impact, ownership, and required decisions.
• Partner with business leaders to establish corrective action plans, assign accountability, monitor delivery, and verify that remediation produces sustainable improvement.
• Drive calibration, training, and continuous improvement initiatives based on review outcomes, regulatory developments, complaints, litigation, and other quality indicators.
• Maintain effective governance, documentation, issue escalation, and quality controls across the end-to-end review process.
• Serve as the senior point of contact for claims quality assurance matters and provide practical, commercially balanced advice to leaders and stakeholders.
• Monitor program effectiveness through meaningful performance and risk indicators, and adjust priorities, resources, and review coverage as needed.

Our Must Haves

• 10+ years of progressive multi-line claims experience, including significant responsibility for claims quality assurance, auditing, compliance, or operational risk.
• Demonstrated experience leading, coaching, and developing a team, or providing sustained functional leadership across a quality assurance program.
• Deep knowledge of claims handling practices, regulatory expectations, state DOI standards, compliance, and operational risk.
• Experience working collaboratively across multiple internal and external teams, including third-party administrators and suppliers.
• Proven ability to build effective relationships and influence stakeholders at all levels of the organization, supported by strong facilitation and written and verbal communication skills.
• Proven ability to analyze complex review findings and data and translate them into clear executive-level insights, risk assessments, and actionable recommendations.
• Sound judgment, strong organization, and change leadership, with the ability to balance competing priorities, respond to emerging risks, and apply a pragmatic, commercial, customer-focused, and solution-oriented approach.
• A strong track record of driving corrective action, improving processes, and reducing repeat quality deficiencies.

Desirable Experience and Qualifications

• Demonstrable subject-matter expertise in claims quality, technical claims handling, or regulatory compliance.
• Experience designing or enhancing quality frameworks, audit methodologies, governance arrangements, or management reporting.
• Experience overseeing TPA quality, vendor performance, or delegated claims arrangements.
• Experience in General Liability, Professional Liability, Property/Inland Marine, or other specialty lines.
• A relevant professional designation in insurance, claims, audit, or compliance.

Hiscox Values

• Courage: Dare to take a risk
• Ownership: Passionate, commercial and accountable
• Integrity: Do the right thing, however hard
• Connected: Together, build something better
• Human: Clear, fair and inclusive

Salary Range

Salary Range: $100-$130k The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Please note that this position is hybrid and requires two (2) days in our office weekly.

What Hiscox USA Offers

• Competitive salary and bonus (based on personal & company performance)
• 401(k) with competitive company matching
• Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
• Company paid group term life, short-term disability and long-term disability coverage
• Paid parental leave
• 4-week paid sabbatical after every 5 years of service
• Financial Adoption Assistance and Medical Travel Reimbursement Programs
• Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
• Recipient of 2024 Cigna’s Well-Being Award for having a best-in-class health and wellness program
• Dynamic, creative and values-driven culture
• Modern and open office spaces, complimentary drinks

About Hiscox

As an international specialist insurer, we are far removed from the world of mass market insurance products. Instead, we are selective and focus on our key areas of expertise and strength - all of which is underpinned by a culture that encourages us to challenge convention and always look for a better way of doing things. We insure the unique and the interesting. And we search for the same when it comes to talented people. Hiscox is full of smart, reliable human beings that look out for customers and each other. We believe in doing the right thing, making good and rebuilding when things go wrong. Everyone is encouraged to think creatively, challenge the status quo and look for solutions. Scratch beneath the surface and you will find a business that is solid, but slightly contrary. We like to do things differently and constantly seek to evolve. We might have been around for a long time (our roots go back to 1901), but we are young in many ways, ambitious and going places. Some people might say insurance is dull, but life at Hiscox is anything but.

About Hiscox USA

Hiscox USA was established in 2006 to focus on the needs underserved and specialty commercial clients via both the regional broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group. Today, Hiscox USA has a talent force of about 400 employees mostly operating out of 6 major cities. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism.