Senior Claims QA & Governance Leader

Hiscox; Atlanta, Chicago (GA, IL); Hybrid; USD 100.000 - 130.000; Vollzeit

Benefits dieser Stelle

Health insurance

401(k) matching

Paid parental leave

Sabbatical after 5 years

Disability coverage

Fitness program reimbursement

Zusammenfassung

Hiscox USA is seeking a seasoned Claims Quality Assurance Manager to lead the quality assurance program across internal and third-party administrator operations. You will own the QA framework, guide risk-based review strategies, and drive sustainable improvements in claims handling.

The role partners with Claims Leadership, Compliance, Legal, and Operations to ensure regulatory alignment with Hiscox Best Practices.

Qualifikationen

• 10+ years of progressive multi-line claims experience, including significant responsibility for claims quality assurance, auditing, compliance, or operational risk.
• 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.

Aufgaben

• 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.

Kenntnisse

Leadership

Stakeholder influence

Data analysis

Regulatory knowledge

Change management

Ausbildung

Professional designation in insurance, claims, audit, or compliance

Jobbeschreibung

Hiscox USA is seeking a seasoned Claims Quality Assurance Manager to lead the quality assurance program across internal and third-party administrator operations. You will own the QA framework, guide risk-based review strategies, and drive sustainable improvements in claims handling.

The role partners with Claims Leadership, Compliance, Legal, and Operations to ensure regulatory alignment with Hiscox Best Practices.