Quality Assessment Claims Specialist

Responsibilities

• Conduct structured quality reviews of claims intake calls, tickets, and customer interactions against a defined rubric.
• Evaluate documentation accuracy, SOP adherence, privacy and regulatory compliance, tone, and professionalism.
• Score interactions using a weighted rubric and maintain consistent standards across reviewers.
• Meet weekly audit volume and coverage targets.
• Participate in calibration sessions with QA reviewers, Team Leads, and Senior Specialists.
• Identify rubric ambiguities and propose updates as workflows and tools change.
• Deliver clear, actionable feedback to specialists and Team Leads.
• Partner with Team Leads and Trainers to identify coaching opportunities and recurring errors.
• Track and report QA trends, including accuracy rates, common errors, and compliance gaps.
• Identify tooling, SOP, and training gaps and recommend improvements.
• Support audits, data reconciliation, and new-product rollouts.

Requirements

• 2+ years of experience in claims processing, customer support, or a related operations role.
• Strong knowledge of claims intake processes, documentation standards, and relevant compliance requirements.
• Excellent listening, written, and verbal communication skills.
• Ability to deliver constructive feedback.
• Strong attention to detail and consistency, with the ability to make judgment calls against a rubric.
• Ability to work independently while staying calibrated with a broader QA team.
• Comfort using spreadsheets, dashboards, and internal QA tooling for data tracking and reporting.

Nice-to-haves

• Claims, insurance, or contact-center QA experience.
• Prior audit or coaching experience.

Compensation and Benefits

• Nashville-area base pay range: $50,180–$62,730, excluding potential equity, bonus, and benefits.
• Medical, dental, and vision insurance options.
• Mental health benefits.
• Family-building, child-care, and pet benefits.
• 401(k) plan with company match.
• Paid holidays and paid time off.
• 18 weeks of paid parental leave.
• Subsidized commuter benefits.
• Monthly Lyft credits and complimentary Lyft Pink membership.