Pie Insurance
Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance.
Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make.
The Senior Claims Quality Assurance Auditor will conduct regular audits and assessments of Pie's claims handling processes to ensure adherence to Claims Best Practices, regulatory standards, and internal guidelines. This role is responsible for reviewing claim files for compliance, identifying areas of non-compliance, and recommending corrective actions to improve claims quality. The auditor will collaborate with Claims teams, prepare detailed audit reports, and support the development of quality control policies and training programs that drive continuous improvement in claims performance and ensure regulatory compliance.
Claims Audit & Assessment
Conduct regular audits and assessments of quality management systems and claims handling processes
Review claim files to verify compliance with regulatory standards, statutory requirements, and internal guidelines
Evaluate claims for adherence to Pie's Claims Best Practices and quality standards
Assess claim documentation, investigation techniques, reserve adequacy, and settlement practices
Identify areas of non-compliance and recommend corrective actions to address deficiencies
Established audit methodologies and sampling techniques to ensure comprehensive evaluations
Documentation & Reporting
Document audit findings with clear, detailed explanations of deficiencies and best practices observed
Prepare comprehensive audit reports for management that include findings, recommendations, and action items
Analyze data to identify trends, patterns, and areas for improvement across the claims organization
Provide timely feedback to adjusters and Claims leadership on audit results
Maintain accurate records of all audits, findings, and corrective action plans
Quality Control & Process Development
Collaborate with various departments to ensure quality standards are met consistently
Develop and update quality control policies and procedures based on audit findings and regulatory changes
Assist in developing quality assurance goals and objectives aligned with department strategies
Recommend process improvements to enhance claims quality and operational efficiency
Support the implementation of new quality standards and best practices
Compliance & Corrective Action Monitoring
Monitor the implementation and effectiveness of corrective and preventive actions
Track remediation efforts to ensure deficiencies are addressed in a timely manner
Verify that corrective actions result in sustained improvements in claims quality
Coordinate with external auditors and facilitate external audit processes when needed
Stay current with regulatory changes and industry best practices that impact claims quality
Training & Knowledge Sharing
Train staff on quality assurance policies, procedures, and industry best practices
Provide coaching and guidance to adjusters on claim handling techniques and compliance requirements
Conduct training sessions on common audit findings and remediation strategies
Knowledge of regulatory requirements and Claims Best Practices with Claims teams
Support Claims Learning & Development initiatives with quality-focused training content
Cross-Functional Collaboration
Partner with Claims Adjudication team to address quality issues and implement improvements
Work with Claims Regulatory Compliance team to ensure audits capture all compliance requirements
Collaborate with Claims Learning & Development team to develop targeted training based on audit findings
Coordinate with Claims Data & Analytics team to support quality reporting and trend analysis
Communicate with Claims leadership on quality trends and recommended actions
Required Experience & Education
High School diploma or GED required; Bachelor's degree in Business Administration, Risk Management, or related field preferred
Minimum 8 years of workers' compensation claims experience with strong understanding of claim handling practices
3+ years of experience in claims auditing, quality assurance, or compliance roles preferred
Strong knowledge of Claims Best Practices and regulatory requirements across multiple jurisdictions
Experience conducting claim file reviews and documenting audit findings
Technical & Analytical Skills
Advanced knowledge of workers' compensation claim handling processes, regulations, and best practices
Strong understanding of statutory and federal compliance requirements
Proficiency in audit methodologies, sampling techniques, and evaluation criteria
Ability to analyze complex claim data and identify trends and patterns
Strong attention to detail with ability to identify deficiencies and compliance issues
Excellent written communication skills for preparing clear, detailed audit reports
Proficiency with claims management systems and Microsoft Office Suite
Communication & Interpersonal Skills
Strong verbal and written communication skills for presenting audit findings and recommendations
Ability to provide constructive feedback to adjusters and Claims teams in a professional manner
Experience training staff on policies, procedures, and best practices
Collaborative approach with ability to build relationships across Claims departments
Ability to communicate effectively with all levels of the organization
Strong interpersonal skills with ability to handle sensitive or difficult conversations
P4 Advanced Level Competencies
Exhibits advanced wide-ranging experience using in-depth professional knowledge and company objectives
Ability to direct application of existing principles and guide development of new policies and ideas
Goes to advisor for others on complex claim quality and compliance matters
Understands and works on complex issues where analysis requires in-depth evaluation of multiple factors
Determines methods and procedures on new audit assignments and initiatives
Consistently demonstrates curiosity, tenacity, flexibility, and adaptability in addressing quality issues
Seeks to understand multiple points of view and presents findings in a direct and open manner
Creates win/win solutions that demonstrate innovation and creativity in addressing quality deficiencies
Evaluates and prioritizes the needs of multiple stakeholders and builds buy-in for recommendations
Personal Attributes
Detail-oriented with commitment to accuracy and objectivity in audit evaluations
Self-starter with ability to work independently and manage multiple audits simultaneously
Strong analytical mindset with ability to think critically about claim quality issues
Proactive approach to identifying compliance risks and quality deficiencies
Professional demeanor with ability to maintain confidentiality
Commitment to continuous learning and staying current with industry developments
Ability to balance quality standards with operational realities
The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process.
Competitive cash compensation
A piece of the pie (in the form of equity)
Comprehensive health plans
Generous PTO
Future focused 401k match
Generous parental and caregiver leave
Our core values are more than just a poster on the wall; they’re tangibly reflected in our work
Our goal is to make all aspects of working with us as easy as pie. That includes our offer process. When we’ve identified a talented individual who we’d like to be a Pie-oneer, we work hard to present an equitable and fair offer. We look at the candidate’s knowledge, skills, and experience, along with their compensation expectations and align that with our company equity processes to determine our offer ranges.
Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members.
Unless otherwise specified, this role is remote. Remote team members must live and work in the United States (territories excluded) and have access to reliable, high-speed internet.
Pie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic.
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Safety First: Pie Insurance is committed to your security during the recruitment process. We will never ask you for credit card information or ask you to purchase any equipment during our interview or onboarding process.
