Claims Quality Assurance Specialist – Operations

Pacific Asset Management, LLC; Charlotte (NC); On-site; USD 46,838 - 59,236; Full time

Benefits offered by this job

Medical, Dental, Vision

401k with company match

Paid Time Off and Holidays

Job summary

Pacific Life Insurance Company is seeking an Operations Quality Assurance Specialist to join the Consumer Markets Division in Omaha, NE or Charlotte, NC. You will perform detailed quality audits across Pay QA, Set-Up QA, and Follow-Up QA to ensure payment accuracy and compliance, and you will document findings with actionable corrective actions.

You will partner with claims leaders and processors to clarify expectations, reinforce procedures, and drive continuous improvement in claim quality and

Qualifications

• 1–4 years of experience in claims processing or claims quality assurance.
• Strong analytical and critical thinking skills to identify patterns and risks in QA results.
• Excellent attention to detail and documentation accuracy.
• Ability to interpret claims procedures and apply them consistently.

Responsibilities

• Perform detailed quality audits of claims transactions across Pay QA, Set-Up QA, and Follow-Up QA.
• Evaluate claims processing for adherence to procedures, authority guidelines, controls, regulatory requirements, service standards, and customer-focused claim handling expectations.
• Document QA findings with defect type, root cause, severity, risk impact, coaching opportunity, and recommended corrective action.
• Partner with claims leaders, processors, trainers, and business partners to clarify expectations, reinforce procedures, and support corrective action planning when quality gaps are identified.
• Analyze QA results to identify trends in payment errors, setup accuracy, missing or incomplete documentation, follow-up timeliness, procedural gaps, and recurring claim handling themes.

Skills

Claims processing

Quality assurance

Auditing

Analytical thinking

Regulatory compliance

Communication

Cross-functional collaboration

Job description

Pacific Life Insurance Company is seeking an Operations Quality Assurance Specialist to join the Consumer Markets Division in Omaha, NE or Charlotte, NC. You will perform detailed quality audits across Pay QA, Set-Up QA, and Follow-Up QA to ensure payment accuracy and compliance, and you will document findings with actionable corrective actions.

You will partner with claims leaders and processors to clarify expectations, reinforce procedures, and drive continuous improvement in claim quality and