Quality Assurance, Risk Control & Special Investigations Analyst

What you'd do

• Interaction Auditing: Conduct comprehensive quality audits of inbound and outbound call center interactions, ensuring accuracy, regulatory compliance, and adherence to TPA standard operating procedures.
• Form Review: Review and audit completed service and administrative forms (e.g., policy changes, beneficiary updates) for completeness, accuracy, and proper processing workflow.
• Feedback & Coaching: Deliver timely, objective, and constructive feedback and coaching to call center agents and team leads to improve service quality and transaction accuracy.
• Reporting: Track, analyze, and report on key TPA and QA metrics and trends, identifying root causes of errors and compliance gaps.
• Pre-Referral Case Review: Act as the initial point of contact for internal fraud referrals (SIU). Review and analyze cases flagged for potential fraudulent activity, including claims, policy changes, and applications.
• Evidence Gathering: Collect, organize, and summarize documentation and system history related to suspicious cases.
• Triage & Escalation: Conduct preliminary analysis to determine the validity of the fraud concern. Prepare and present well-documented case files for formal referral to the insurance carrier’s Special Investigations Unit (SIU).
• Documentation: Maintain detailed and confidential records of all investigation activities and findings in accordance with internal protocol and regulatory requirements.
• Control Monitoring: Execute periodic and event-based monitoring of defined key operational and financial controls within the TPA processing environment to confirm effectiveness.
• Risk Reporting: Assist in the reporting of control gaps, deficiencies, and emerging risks to the Risk and Compliance leadership.

What they want

• Minimum of 2 years of professional experience in Quality Assurance (QA), Compliance, Fraud Analysis, or an operational role within the life insurance, financial services, or TPA industry.
• Strong working knowledge of life insurance policy lifecycle, administrative forms, and general TPA operating procedures.
• Proven ability to analyze complex transaction histories, identify unusual patterns, and draw sound conclusions for risk and fraud assessment.
• Exceptional verbal and written communication skills, with the ability to deliver difficult feedback constructively and concisely summarize investigation findings for executive review.
• Experience with a formal quality monitoring system (e.g., call recording, QA software) preferred
• Familiarity with state and federal regulations governing life insurance (e.g., anti-money laundering, privacy) preferred
• Experience in conducting internal control audits (SOX, SOC) preferred
• Experience creating quality assurance checklists within QA systems preferred
• Competitive salary and equity based on role
• Policies and managers that support work/life balance, like our flexible paid time off and parental leave programs