Senior Insurance Operations Quality Assurance Specialist

Horace Mann

. Conduct a designated number of daily quality audits for assigned departments.

Posted 9/24/2026full-timeRemote • United StatesSenior💰 $57,500 - $71,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in conducting quality audits, analyzing complex Supplemental Health claims, and ensuring compliance with regulatory requirements. Proficient in interpreting policy provisions and implementing operational improvements through data analysis and feedback.

Highest-signal resume keywords

Quality Audit ExperienceSupplemental Health Claims AnalysisRegulatory CompliancePolicy InterpretationData Analysis

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Quality AssuranceClaims Processing WorkflowsRoot-Cause AnalysisAdvanced Claims AnalysisAudit ProceduresOperational ImprovementDocumentation of Audit FindingsCompliance EvaluationTrend AnalysisTechnical Guidance

Soft Skills

Attention to DetailAnalytical SkillsCritical ThinkingWritten CommunicationVerbal Communication

Tools & Technologies

Quality Audit Databases

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Health ClaimsSupplemental HealthPolicy ServicesUnderwritingCustomer ServiceClaims AdministrationOperational ExcellenceContinuous Improvement

About the role

Key responsibilities & impact

Conduct a designated number of daily quality audits for assigned departments.
Evaluate work for accuracy, completeness, and compliance with company policies, procedures, and applicable regulatory requirements.
Perform audits across Claims, Customer Service, New Business, Underwriting, and Policy Services.
Conduct ad hoc and special audits.
Document audit findings and results in Quality Audit databases.
Audit complex, high-risk, and non-routine Supplemental Health claims.
Interpret and apply policy provisions, benefit requirements, limitations, exclusions, and plan language.
Assess claim handling from initial review through final disposition.
Analyze information, identify inconsistencies or missing documentation, and assess whether claim decisions are supported.
Identify processing errors, recurring trends, root causes, and operational improvement opportunities.
Provide feedback to leadership and partner with operational leaders on corrective actions and process improvements.
Assist with development, implementation, and refinement of Quality Audit programs.
Support audit procedures for new products, systems, and services.
Align audit procedures with business processes, policies, industry standards, and regulatory requirements.
Assist the Audit Manager with training, coaching, calibration exercises, and technical guidance.

Requirements

What you’ll need

High School Diploma or GED.
3+ years of health claims experience.
Strong understanding of claims processing workflows and Supplemental Health claim administration.
Ability to interpret policy provisions, benefit requirements, limitations, and exclusions.
Exceptional attention to detail and strong analytical and critical-thinking skills.
Ability to evaluate complex information and exercise sound judgment.
Strong written and verbal communication skills.
Previous Quality Audit or Quality Assurance experience (preferred).
Experience auditing complex Supplemental Health claims (preferred).
Experience providing technical guidance, training, or calibration support (preferred).
Advanced claims analysis.
Quality assurance and auditing.
Policy and benefit interpretation.
Root-cause analysis.
Regulatory and procedural compliance.
Data and trend analysis.
Coaching and knowledge sharing.
Operational excellence and continuous improvement.

Benefits

Comp & perks

Bonus eligibility
Special rates and benefits for educators (company offering)