Claims Quality & Compliance Auditor

Sedgwick; Miami (FL); Remote; USD 50,000 - 70,000; Full time

Benefits offered by this job

Medical benefits

401k and matching

PTO

Disability insurance

Life insurance

Employee assistance

Job summary

Sedgwick is seeking a Performance Assurance Analyst to monitor claims activities, audit files, and identify trends in compliance. This role emphasizes training and quality improvement across local, regional, and national levels.

You will administer the quality program, present audit results, coordinate TPM initiatives, mentor colleagues, and maintain technical claims expertise. Travel may be required. Competitive benefits apply.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• High school diploma or GED required.
• Six (6) years of claims experience or equivalent combination of education and experience required, including one (1) year of claims auditing experience required or equivalent combination of education and experience.
• Strong knowledge of claims management practices and procedures.
• Understanding of quality and auditing processes.
• Excellent oral and written communication, including presentation skills.
• Strong analytical skills with the ability to interpret data.
• Problem-solving and negotiation skills.
• Excellent organizational skills.
• Excellent interpersonal skills.
• Ability to work in a team environment.
• Ability to use a personal computer.

Responsibilities

• Administers the quality program; conducts local office file audits using the Compass tool.
• Presents audit results to local, regional and national management as requested.
• Assists Total Performance Manager in coordinating and implementing Sedgwick business unit (SBU) and national quality initiatives at the local and/or SBU level.
• Recommends training and improvement activities needed to meet established operational and technical audit requirements.
• Participates in colleague coaching, mentoring and group training as needed.
• Participates in quarterly national total performance management (TPM) review meetings with national TPM and Quality leaders.
• Maintains technical claims and jurisdictional expertise.
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as needed.

Skills

Claims management

Quality auditing

Communication skills

Data analysis

Problem solving

Organization

Interpersonal skills

Team player

PC literacy

Education

Bachelor's degree preferred

High school diploma or GED required

Job description

Sedgwick is seeking a Performance Assurance Analyst to monitor claims activities, audit files, and identify trends in compliance. This role emphasizes training and quality improvement across local, regional, and national levels.

You will administer the quality program, present audit results, coordinate TPM initiatives, mentor colleagues, and maintain technical claims expertise. Travel may be required. Competitive benefits apply.