Quality Assurance, Risk Control & Special Investigations Analyst
This analyst audits customer interactions and administrative forms, investigates potential fraud referrals, monitors operational controls, and supports risk mitigation across life insurance TPA operations. The role requires at least two years of relevant experience and strong analytical, communication, and regulatory-compliance skills.
About the job
Responsibilities
- Conduct quality audits of inbound and outbound call center interactions for accuracy, regulatory compliance, and adherence to third-party administrator (TPA) procedures.
- Review service and administrative forms, including policy changes and beneficiary updates, for completeness, accuracy, and correct workflow processing.
- Provide objective feedback and coaching to call center agents and team leads.
- Track, analyze, and report quality assurance and TPA metrics, trends, root causes, errors, and compliance gaps.
- Review internal fraud referrals involving claims, policy changes, and applications.
- Gather, organize, and summarize documentation and system history for suspicious cases.
- Triage potential fraud concerns and prepare case files for referral to an insurer’s Special Investigations Unit (SIU).
- Maintain confidential investigation records according to internal protocols and regulatory requirements.
- Monitor operational and financial controls and report control gaps, deficiencies, and emerging risks.
- Collaborate with Operations and Training teams on process changes, control enhancements, and documentation improvements.
- Support compliance, fraud-awareness, and quality-standards training.
Requirements
- At least 2 years of professional experience in quality assurance, compliance, fraud analysis, or operations within life insurance, financial services, or the TPA industry.
- Working knowledge of the life insurance policy lifecycle, administrative forms, and TPA procedures.
- Ability to analyze complex transaction histories, identify unusual patterns, and assess risk and fraud concerns.
- Excellent verbal and written communication skills, including constructive feedback and concise investigation summaries.
Nice-to-haves
- Experience with call recording or quality assurance software.
- Familiarity with life insurance regulations, including anti-money laundering and privacy requirements.
- Experience conducting SOX or SOC internal control audits.
- Experience creating quality assurance checklists in QA systems.
Compensation & Benefits
- Competitive salary and equity based on role.
- Flexible paid time off and parental leave.
- 100% paid-premium option for medical, dental, and vision insurance.
- Lifestyle stipend supporting physical, emotional, and financial wellbeing.
- Flexible work-from-home policy.
Skills
Quality Assurance, Fraud Analysis, Compliance, Life Insurance, Third-Party Administration, Risk Assessment, Internal Controls, Sox, Soc, Anti-Money Laundering, Call Recording Software, Quality Assurance Software, Process Improvement, Regulatory Compliance, Case Management
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