Senior Claims Audit & Quality Assurance Lead

AXIS (AXIS Capital); Alpharetta (GA); Hybrid; USD 140,000 - 160,000; Full time

Benefits offered by this job

Hybrid work environment

Incentive compensation

Comprehensive benefits

Job summary

AXIS Capital in Alpharetta, GA seeks a seasoned Claims Audit Program Manager to lead NA audit programs across lines. You will oversee end-to-end audits, coordinate with TPAs, Compliance, Legal, and Claims Leadership, and drive improvements in standards, scoring, and reporting.

Ideal candidates have 6–10 years in commercial P&C insurance, experience managing audits, and strong analytics with Excel, PowerPoint, and dashboards.

Qualifications

• 6–10 years of experience in commercial P&C insurance, reinsurance, specialty claims, claims audit, quality assurance, compliance, operational risk, or a related discipline.
• Minimum 3 years of experience supporting or managing claims audits, quality assurance reviews, compliance monitoring, operational controls, or remediation tracking.
• Experience working with TPAs, outsourced claims partners, audit vendors, or vendor oversight programs.
• Experience auditing specialty claim files across multiple lines of business and supporting technical claim quality reviews.
• Experience developing audit reports, dashboards, metrics, scorecards, or performance analytics for leadership review.
• Strong proficiency in Excel, PowerPoint, Word, and reporting tools.

Responsibilities

• Lead and report on the North America claim handler audit program, TPA oversight audit program, and leadership quality control file review program across multiple lines of business.
• Manage end-to-end audit execution, including planning, scope, scheduling, sample selection, file collection, stakeholder communications, and audit readiness.
• Coordinate with claim leaders, specialty claim handlers, TPAs, audit vendors, Compliance, Legal, Internal Audit, and Operations to ensure consistent, timely audit delivery.
• Enhance audit standards, questionnaires, scorecards, and methodologies in line with claim best practices, regulatory expectations, and technical excellence standards.
• Review audit observations across coverage, liability, damages, reserving, litigation management, settlement strategy, documentation quality, compliance, and claim handling controls.
• Track findings, action plans, remediation activities, owner accountability, due dates, and closure evidence.
• Gather, validate, and analyze audit results, quality assurance data, compliance findings, and technical claim handling trends.
• Develop dashboards, scorecards, and management reports covering quality review results, technical audit outcomes, recurring themes, risk areas, trends, and improvement opportunities.
• Prepare monthly, quarterly, and annual reporting for Claims leadership and governance forums, covering claim handler audit results, TPA oversight audit results, and leadership quality control file review outcomes.
• Measure audit effectiveness, remediation progress, transparency, accountability, and control discipline.
• Partner with Compliance, Legal, Internal Audit, Claims Operations, and Claims Leadership to align audit activity with regulatory, governance, and operational risk priorities.
• Monitor findings related to Medicare, regulatory obligations, documentation standards, claim handling controls, and other compliance requirements.
• Maintain action plans that address findings, strengthen controls, and promote consistent claim handling across North America specialty claim teams, TPA claim programs, and leadership quality control file reviews.
• Escalate material issues, recurring trends, control gaps, and remediation delays to appropriate leaders and governance forums.
• Improve fraud identification, referral quality, and SIU oversight.

Skills

Auditing

Quality assurance

Stakeholder management

Claims knowledge

Data analysis

Excel

PowerPoint

Project coordination

Vendor management

Communication

Education

Bachelor's degree

Tools

Excel

PowerPoint

Word

Job description

AXIS Capital in Alpharetta, GA seeks a seasoned Claims Audit Program Manager to lead NA audit programs across lines. You will oversee end-to-end audits, coordinate with TPAs, Compliance, Legal, and Claims Leadership, and drive improvements in standards, scoring, and reporting.

Ideal candidates have 6–10 years in commercial P&C insurance, experience managing audits, and strong analytics with Excel, PowerPoint, and dashboards.