Claims Quality Assurance

Role Overview

The Claims Quality Assurance role serves as the technical QA expert for Claims Operations, auditing compliance with CorVel, industry, and carrier claim-handling standards. You will evaluate claim handling quality, accuracy, and timeliness across key areas such as coverage analysis, investigation, valuation, reserving, compliance, and claim disposition.

Responsibilities

• Act as a technical QA lead for assigned offices or departments.
• Lead QA projects and coordinate quality efforts with senior leadership.
• Support the Claims Quality Assurance Program and the EC Operations Team by developing and implementing quality improvement strategies.
• Build, present, execute, and calibrate Quality Assurance Training sessions, including integration into claims training programs and calibration exercises (policy, systems, workflows, statutes).
• Create and maintain QA training materials and adjust them based on calibration and target outcomes.
• Report on pending payments, reserves, Adjuster POA/Supervisor review compliance, leakage, and other operational performance and compliance metrics.
• Monitor claim financials and follow up on audits to identify reserve deficiencies and issues related to claim liability/compensability.
• Ensure carrier reporting deficiencies are corrected.
• Maintain and update quality standards in real time (quality, quantity, and turnaround-time expectations).
• Perform technical testing of software/websites/technical products to identify and resolve defects and claim-processing issues.
• Review product/claim process specifications; define test parameters (functionality, validity, accuracy, reliability, and compliance).
• Report defects to EC Operations and BOT teams, recommending solutions and improvements.
• Submit operational QA reporting at defined intervals, including written corrective action plans.
• Participate in strategic operational calls when significant deficiencies are identified.
• Work with EC Operations to implement QA corrective action plans required by carriers/clients.

Requirements

• Strong written and verbal communication skills; ability to serve internal and external stakeholders.
• Quantitative, analytical, and interpretive abilities to analyze trends and results.
• Demonstrated leadership and mentorship capability.
• Ability to prioritize and manage multiple responsibilities in a fast-paced environment.
• Proficiency with Microsoft Office.
• Strong interpersonal, time management, project management, and organizational skills.
• Knowledge of claims administration processes (including ancillary services).
• Ability to remain professional and effective under stress.

Nice-to-have / Additional signals

• Experience as a technical QA lead in claims operations (implied by ownership of QA programs, calibration, and training execution).