Sr Specialty Claims Analyst | QA

Global Accounting Network Limited; United States; On-site; USD 90,000 - 130,000; Full time

Job summary

Global Accounting Network Limited is seeking a seasoned specialist to enhance quality, regulatory integrity, and oversight within the Specialty Claims function. The role reports to the VP of Specialty Claims Compliance and focuses on claims reviews, controls, and governance.

The ideal candidate combines deep Specialty claims expertise with strong analytics and practical recommendations to improve operations and compliance, including licensing, reinsurance reporting, and AI tool governance.

Qualifications

• Extensive experience in Specialty claims and quality assurance.
• Knowledge of Cyber, Financial Institutions, Management Liability, and Professional Liability.
• Strong compliance with state and federal insurance regulations.
• Ability to identify deficiencies and recommend remedial actions.
• Experience with claims administration platforms, especially Guidewire ClaimCenter.
• Excellent communication and professional handling of sensitive claims.
• Willingness to travel periodically.

Responsibilities

• Quality & file review of Specialty claims to ensure compliance and consistency.
• Risk identification & controls to uncover deficiencies.
• AI oversight & quality controls of AI-enabled outputs.
• Remediation & process improvement with cross-functional teams.
• Training & technical guidance to staff.
• Management reporting & analytics for leadership.
• Regulatory & industry monitoring to incorporate findings.
• Licensing administration for claims staff.
• Reinsurance & significant loss reporting coordination.

Skills

Specialty claims

Quality assurance

Regulatory compliance

Analytical skills

Attention to detail

Communication skills

Travel willingness

Education

Insurance certifications

Tools

Guidewire ClaimCenter

EDMS (Electronic Document Management Systems)

Job description

An established insurance organization is seeking a seasoned professional to support the quality, consistency, and regulatory integrity of its Specialty Claims function. Reporting to the Vice President of Specialty Claims Compliance, this individual will contribute to claims oversight, quality control, compliance monitoring, and management reporting.

The role combines technical claims expertise with analytical review and governance responsibilities. Key areas of focus include evaluating complex claims, strengthening internal controls, monitoring emerging risks, and coordinating essential reporting requirements related to reinsurance, significant losses, and claims personnel licensing. The specialist will also help assess the appropriate use of AI-driven tools within claims operations and support continuous improvement initiatives across the function.

The ideal candidate brings a strong understanding of Specialty claims practices, sound analytical judgment, and the ability to translate review findings into practical recommendations that improve operational effectiveness and compliance.

Key Responsibilities

• Claims Quality & File Review: Conduct detailed assessments of Specialty claims files to evaluate decision-making, documentation, procedural consistency, and adherence to internal guidelines and applicable regulatory standards. Prioritize complex, sensitive, and higher-exposure claims where appropriate.
• Risk Identification & Controls: Analyze claims handling practices to uncover recurring deficiencies, process weaknesses, and potential exposure involving litigation, regulatory scrutiny, or errors and omissions.
• AI Oversight & Quality Controls: Review claims-related outputs generated through AI-enabled tools, identify potential inaccuracies or inconsistencies, and help maintain appropriate review procedures and governance safeguards.
• Remediation & Process Improvement: Work with Claims management, Compliance, and operational teams to communicate findings, monitor corrective actions, and promote consistent application of claims standards.
• Training & Technical Guidance: Develop and deliver focused coaching, educational materials, and guidance to address identified deficiencies, reinforce best practices, and improve claims handling quality.
• Management Reporting & Analytics: Prepare meaningful reports on quality reviews, control effectiveness, emerging patterns, and recommended improvements to support leadership decision-making.
• Regulatory & Industry Monitoring: Track relevant legislative and regulatory changes, industry developments, and evolving claims risks; incorporate applicable findings into review priorities and training initiatives.
• Licensing Administration: Help oversee claims staff licensing obligations by maintaining accurate records, monitoring compliance, and supporting required documentation and follow-up.
• Reinsurance & Significant Loss Reporting: Coordinate and monitor reporting workflows for reinsurance-related matters and large losses, supporting accurate and timely submission of required information to internal and external stakeholders.

Required Qualifications

• At least seven years of experience in Specialty claims, claims quality assurance, insurance compliance, or a closely related discipline.
• Working knowledge of Specialty lines, particularly Cyber, Financial Institutions, Management Liability, and Professional Liability.
• Familiarity with applicable state and federal insurance regulations and the compliance requirements affecting claims operations.
• Proven ability to assess complex claims, evaluate handling decisions, and identify procedural, documentation, quality, or control deficiencies.
• Strong analytical capabilities, including the ability to interpret claims information, evaluate QA results, and identify meaningful trends and risk indicators.
• Exceptional attention to detail, sound judgment, and the ability to handle sensitive claims matters professionally.
• Experience working with claims administration platforms, preferably Guidewire ClaimCenter, along with electronic document management systems.
• Strong written and verbal communication skills, including the ability to present findings, recommend improvements, and work collaboratively with claims professionals and senior leadership.
• Relevant insurance, claims, or compliance certifications are advantageous.
• Willingness to travel periodically based on business needs.