Senior Manager, Claims QA & Audit - Hybrid

AXIS (AXIS Capital); Princeton (NJ); Hybrid; USD 140,000 - 160,000; Full time

Benefits offered by this job

Hybrid work environment (3 days in the

Competitive benefits package

Job summary

AXIS Capital seeks a Senior Manager, Quality Assurance and Compliance for North America Claims. You will lead audits, oversee TPA relationships, and drive quality improvements across multiple lines of business.

You will report to the Head of QA and Compliance and coordinate with Compliance, Legal, and Internal Audit to strengthen controls. The role requires strong technical claims judgment, oversight of audits, and ability to translate findings into actionable improvements.

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 technical claims judgment and ability to assess claim handling quality across coverage, liability, damages, reserving, litigation management, settlement strategy, documentation quality, compliance, and claim handling controls.
• Strong analytical, communication, project coordination, organizational, stakeholder management, and vendor management skills.
• Ability to identify themes, root causes, risks, control gaps, performance improvement opportunities, and remediation priorities.
• Ability to manage multiple audits, stakeholders, priorities, and deadlines in a fast-paced environment.
• Strong proficiency in Excel, PowerPoint, Word, and reporting tools.
• Bachelor’s degree required; advanced degree, CPCU, AIC, ARM, CFE, CIA, CPA, JD, or other relevant professional designation preferred.

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.
• Enhance, measure, and report on the SIU and fraud deliverable program as part of the North America claims audit program.
• Assess whether SIU and fraud deliverables are timely, complete, consistent, and aligned with claim handling expectations, regulatory obligations, and technical audit standards.
• Identify themes, control gaps, escalation issues, documentation weaknesses, and opportunities to improve fraud identification, referral quality, and SIU oversight.
• Partner with SIU, Compliance, Claims leadership, TPAs, and audit vendors to strengthen execution, reporting, accountability, and remediation follow-through.
• Use audit and quality control file review insights to improve technical claim quality, consistency, reserving discipline, litigation management, settlement practices, and compliance execution.
• Support updates to claims guidelines, audit protocols, procedures, workflows, controls, and training materials based on audit trends and root-cause analysis.
• Provide practical recommendations to claim leaders, specialty claim handlers, TPAs, and business partners to improve claim outcomes and audit performance.
• Participate in governance meetings, working groups, and initiatives related to claims quality, audit readiness, and technical excellence.
• Build effective relationships across North America Claims, specialty claim teams, TPAs, Compliance, Legal, Internal Audit, Actuarial, Finance, Operations, and Shared Services.
• Manage day-to-day coordination with external audit vendors, including schedules, deliverables, issue tracking, reporting inputs, and performance expectations.
• Provide audit and quality assurance subject matter support to claim leaders, specialty claim handlers, TPA managers, and governance stakeholders.
• Communicate findings, themes, risks, and recommendations clearly to management and senior leadership.

Skills

6–10 years of experience in commercial

3+ years in claims audits

TPA/outsource claims oversight

Auditing specialty claim files

Audit reports & dashboards

Technical claims judgment

Analytical & stakeholder management

Multi-audit management

MS Office proficiency

Education

Bachelor’s degree required; advanced designation preferred

Tools

Excel

PowerPoint

Word

Job description

AXIS Capital seeks a Senior Manager, Quality Assurance and Compliance for North America Claims. You will lead audits, oversee TPA relationships, and drive quality improvements across multiple lines of business.

You will report to the Head of QA and Compliance and coordinate with Compliance, Legal, and Internal Audit to strengthen controls. The role requires strong technical claims judgment, oversight of audits, and ability to translate findings into actionable improvements.