Quality Assurance, Risk Control & Special Investigations Analyst

Bestow • Dallas, TX

52d • $26 - $30 • Hybrid

About The Position

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).

Requirements

• 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.

Nice To Haves

• 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

Responsibilities

• Conduct comprehensive quality audits of inbound and outbound call center interactions, ensuring accuracy, regulatory compliance, and adherence to TPA standard operating procedures.
• Review and audit completed service and administrative forms (e.g., policy changes, beneficiary updates) for completeness, accuracy, and proper processing workflow.
• Deliver timely, objective, and constructive feedback and coaching to call center agents and team leads to improve service quality and transaction accuracy.
• Track, analyze, and report on key TPA and QA metrics and trends, identifying root causes of errors and compliance gaps.
• 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.
• Collect, organize, and summarize documentation and system history related to suspicious cases.
• 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).
• Maintain detailed and confidential records of all investigation activities and findings in accordance with internal protocol and regulatory requirements.
• Execute periodic and event-based monitoring of defined key operational and financial controls within the TPA processing environment to confirm effectiveness.
• Assist in the reporting of control gaps, deficiencies, and emerging risks to the Risk and Compliance leadership.
• Collaborate with Operations and Training teams to develop and implement targeted process changes, control enhancements, and improved documentation to mitigate identified risks.
• 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.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed