Quality Assurance Analyst, Risk Control, Special Investigations

This is a fully remote position, open to applicants in United States.

📋 Description

• Perform thorough quality audits on both inbound and outbound call center interactions.

• Evaluate and audit finalized service and administrative documents for accuracy, completeness, and adherence to proper processing workflow.

• Provide prompt, objective, and constructive feedback as well as coaching to call center agents and team leaders.

• Monitor, analyze, and report on TPA and QA metrics and trends.

• Identify the root causes of errors and compliance deficiencies.

• Review and assess internal fraud referrals related to claims, policy alterations, and applications.

• Gather, organize, and summarize documentation and system history pertinent to suspicious cases.

• Execute preliminary fraud analysis and compile documented case files for submission to the insurance carrier’s Special Investigations Unit.

• Maintain comprehensive and confidential investigation records.

• Oversee established operational and financial controls within the TPA processing framework.

• Report on control deficiencies, gaps, and emerging risks to Risk and Compliance leadership.

• Collaborate with Operations and Training teams to implement process modifications, control enhancements, and documentation upgrades.

• Support compliance, fraud awareness, and quality standards training initiatives.

⛳️ Requirements

• At least 2 years of professional experience in Quality Assurance (QA), Compliance, Fraud Analysis, or a related operational role within the life insurance, financial services, or TPA sector.

• Strong understanding of the life insurance policy lifecycle, administrative documentation, and general TPA operational procedures.

• Proficient in analyzing intricate transaction histories, recognizing unusual patterns, and making sound conclusions for risk and fraud evaluation.

• Excellent verbal and written communication abilities.

• Previous experience with a formal quality monitoring system is preferred.

• Knowledge of state and federal regulations governing life insurance is preferred.

• Experience in conducting internal control audits (SOX, SOC) is preferred.

• Familiarity with creating quality assurance checklists within QA systems is preferred.

• Must be eligible to work in the United States; Bestow utilizes E-Verify to confirm employment eligibility.

🏝️ Benefits

• Competitive salary and equity based on the role.

• Flexible paid time off.

• Parental leave programs.

• 100% paid-premium option for medical, dental, and vision insurance.

• Lifestyle stipend supporting physical, emotional, and financial wellbeing.

• Flexible work-from-home policy.

• Remote and WFH options available.

• State-of-the-art office option in Dallas.

• Initiatives led by employees focused on diversity, equity, and inclusion.