Quality Assurance, Risk Control & Special Investigations Analyst

6 дн. назад

26–30 USD / hourUSARemote

Responsible for ensuring operational integrity, service excellence, and adherence to regulatory standards in life insurance operations.

Обязанности

The Quality Assurance, Risk Control & Special Investigations Analyst is a specialized and critical role responsible for ensuring operational integrity, service excellence, and adherence to regulatory standards across our life insurance Third-Party Administrator (TPA) operations. This individual performs three key functions: auditing call and service interactions, conducting pre-referral fraud investigations while providing supporting documentation regarding alleged fraud inquiries, and monitoring internal controls to drive process improvement and mitigate risk.
This role reports directly to the Customer Experience Manager and is open to hybrid in our Dallas office or Remote (US). #LIREMOTE

Требования

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

Другое

Life insurance is one of the world's most important products. It's also one of the hardest to build, distribute, and modernize. exists to change that.
is a leading vertical technology platform serving some of the largest and most innovative life insurers. Our platform unifies the fragmented, legacy value chain, enabling carriers to launch products in weeks instead of years. Carriers choose us to scale and operate at unprecedented speed, powered by AI and automation.
isn't selling policies. We're building the infrastructure that helps an entire industry move faster, reach more people, and deliver on its promise.
Backed by leading investors (Goldman Sachs, Hedosophia, NEA, Valar, 8VC) and trusted by major carriers, is powered by a team that moves with precision, purpose, and heart. If you want to help reimagine a centuries-old industry with lasting impact, join us.
offers flexible remote/hybrid work, meaningful benefits, equity, and substantial growth opportunities.
uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify.gov .
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.
Process Improvement: Collaborate with Operations and Training teams to develop and implement targeted process changes, control enhancements, and improved documentation to mitigate identified risks.
Training Support: Assist in the development and delivery of training modules related to compliance, fraud awareness, and new quality standards for operations, quality assurance and TPA contact center staff.
At , we’re proud to be awarded for our team members, innovative products, and culture. Our standard benefits include:
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
100% paid-premium option for medical, dental, and vision insurance
Lifestyle stipend to support your physical, emotional, and financial wellbeing
Flexible work-from-home policy and open to remote
Remote and WFH options, as well as a beautiful, state-of-the-art office in Dallas’ Deep Ellum, for those who prefer an office setting
Employee-led diversity, equity, and inclusion initiatives
Recent Employer Awards include:
Best Place for Working Parents 2023 + 2024 + 2025
Great Place to Work Certified, 2022 + 2023 + 2024 + 2025
Built In Best Places to Work, 2022 + 2023 + 2025
Fortune’s Best Workplaces in Texas 2022 + 2023
Fortune’s Best Workplaces in Financial Services and Insurance 2022 + 2023 + 2024
We value diversity at . The company will hire, recruit, and promote regardless of race, color, religion, sex, sexual orientation, gender identity or expression, national origin, pregnancy or maternity, veteran status, or any other status protected by applicable law. We understand the importance of creating a safe and comfortable work environment and encourage individualism and authenticity in every team member.
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