Claims Operations Quality Assurance Specialist

Pacific Life•Charlotte, NC

12d•$32 - $43•Hybrid

About The Position

Pacific Life is seeking talented Operations Quality Assurance Specialists to join our Consumer Markets Division in Omaha, NE or Charlotte, NC. In this role, you will play a critical part in ensuring the accuracy, compliance, and quality of life insurance inforce processing activities. You will conduct detailed transaction audits, identify trends and root causes, and provide actionable insights that improve operational performance, reduce risk, and strengthen service quality across the organization. This is an excellent opportunity for individuals looking to grow their career in operations quality, risk, and process improvement within a leading financial services organization.

Requirements

1–4 years of experience in claims processing, claims quality assurance, auditing, compliance, insurance operations, financial operations, or operational risk/control environments
Strong analytical and critical thinking skills with the ability to identify claim processing patterns, root causes, procedural gaps, and risk trends across QA review results
Exceptional attention to detail and documentation accuracy
Ability to interpret and apply claims procedures consistently while exercising sound judgment in pay, set-up, and follow-up review scenarios
Strong communication and partnership skills with the ability to provide constructive, fact-based feedback to claims processors, leaders, and training partners
Ability to manage multiple priorities in a fast-paced environment
Demonstrated adaptability and learning agility

Nice To Haves

Experience in life insurance claims, financial services, banking, healthcare claims, or other regulated operational environments
Prior experience with claims quality assurance, claim payment review, claim setup review, follow-up review, audit, compliance, or controls work
Knowledge of claims operations, life insurance claim handling, beneficiary/payee review, documentation requirements, payment controls, interest calculation, and post-death interest review
Experience supporting process improvement or operational excellence initiatives

Responsibilities

Perform detailed quality audits of claims transactions across Pay QA, Set-Up QA, and Follow-Up QA, including claim payment accuracy, interest review and calculation, post-death interest, initial claim setup, documentation, beneficiary/payee information, follow-up requirements, and completion of required claim actions
Evaluate claims processing for adherence to established procedures, authority guidelines, controls, regulatory requirements, service standards, and customer-focused claim handling expectations
Document QA findings for pay, set-up, and follow-up reviews, including defect type, root cause, severity, risk impact, coaching opportunity, and recommended corrective action
Partner with claims leaders, processors, trainers, and business partners to clarify expectations, reinforce procedures, and support corrective action planning when quality gaps are identified
Analyze QA results to identify trends in payment errors, setup accuracy, missing or incomplete documentation, follow-up timeliness, procedural gaps, and recurring claim handling themes
Contribute to claims QA reporting and insight development that helps leadership understand risk areas, training needs, workload impacts, and opportunities to improve claim quality and consistency
Support continuous improvement initiatives aimed at increasing quality, efficiency, and consistency
Participate in calibration sessions for Pay QA, Set-Up QA, and Follow-Up QA to ensure review accuracy, consistent scoring, and alignment across QA reviewers and claims operations
Consistently apply sound judgment and accountability when evaluating pay accuracy, interest review and calculation, post-death interest, claim setup completeness, follow-up activity, documentation quality, and adherence to claims procedures
Identify meaningful trends and root causes across Pay QA, Set-Up QA, and Follow-Up QA that help reduce repeat errors, strengthen controls, and improve the customer claim experience
Deliver timely, accurate, objective, and actionable QA findings through clear documentation, consistent scoring, and constructive communication with claims processors and leaders
Build strong partnerships with claims operations stakeholders to support coaching, quality improvement, procedural alignment, and consistent claim handling practices
Contribute to a culture of continuous improvement by using QA insights to support training, reduce risk, improve claim accuracy, and strengthen operational excellence