Lead claims file audits and quality reviews at Pacific Blue Cross, using robust judgement and Disability Management knowledge in a hybrid arrangement.
As an experienced Quality Assurance Advisor, you will independently evaluate claims management practices and compliance. Your findings will become practical recommendations for operational managers. The position also contributes insights to learning, performance management, continuous improvement, and training requirements.
You will manage your review portfolio independently while communicating feedback compassionately and clearly.
Key Responsibilities:
- Review claims files and assess management practices objectively
- Support compliance with insurance requirements through quality oversight
- Summarize findings, trends, risks, and improvement opportunities
- Inform learning modules and continuous training requirements
- Drive consistency across claims management processes
Requirements:
- Certificate in Disability Management or relevant bachelor’s degree
- Five to eight years in claims adjudication or case management
- Complex STD and LTD planning, intervention, and return-to-work experience
- Experience conducting claims audits or quality assurance reviews
- Ability to deliver compassionate, respectful, and firm feedback
Use detailed claims review, compliance evaluation, and recommendation skills to influence stronger practices without direct reports.