Job Description
Role Title: Quality Auditor – Claims Operations Niche and DER
Preston Office
Purpose of the Role:
To ensure the accuracy, compliance, and efficiency of claims processing within a claims operation environment by conducting audits, identifying trends, and driving continuous process improvement initiatives.
Key Responsibilities:
* Conduct regular audits of claims files to assess accuracy, completeness, and adherence to internal policies and regulatory standards.
* Identify errors, inconsistencies, or potential fraud, and escalate findings appropriately.
* Collaborate with claims handlers and team leaders to provide feedback and coaching based on audit results.
* Analyse audit data to identify systemic issues and recommend process enhancements.
* Develop and maintain audit tools, scorecards, and reporting dashboards.
* Support the implementation of corrective actions and monitor their effectiveness.
* Participate in cross-functional projects aimed at improving claims workflows and customer outcomes.
* Stay current with industry regulations, compliance requirements, and best practices.
Process Improvement Focus:
* Lead root cause analysis on recurring audit findings and inefficiencies.
* Partner with operational leaders to redesign workflows and eliminate waste.
* Contribute to the development of training materials and SOPs based on audit insights.
* Track and report on KPIs related to quality and process improvement.
Essential Skills & Experience:
* Experience in claims auditing within a TPA or insurance environment.
* Strong understanding of claims processes, regulatory compliance, and quality assurance principles.
* Analytical mindset with the ability to interpret data and identify trends.
* Excellent communication and interpersonal skills for delivering feedback and influencing change.
* Proficiency in audit software, claims management systems, and Excel.
Desirable Qualifications:
* Familiarity with FCA regulations and TCF (Treating Customers Fairly) principles.
Davies are committed to being a diverse and inclusive workplace. We welcome candidates of all genders, gender identity and expression, neurodiversity, sexual orientation, disability, physical appearance, body size, race, age, nationality, and belief (or lack thereof).
* Join us and enjoy our ever-evolving benefits, including but not limited to:
* Reward platform – discounts for over 800 retailers
* 25 days holiday (rising with service)
* Well-being centre
* Recognition programme
* Paid fertility appointments
* Fostering friendly employer
* Pension - matched contribution at 5%
* Life Assurance (4 x basic salary)
* Development, training, and professional qualification