Quality Control Manager - P & C Claims (TPA)

Raphael and Associates • Rutherford, NJ

5d • Remote

About The Position

We are seeking an experienced Quality Control Manager to join our team. This role will be responsible for developing, implementing, and maintaining quality assurance programs for Property & Casualty claims operations within a Third-Party Administrator (TPA). This role drives accuracy, consistency, compliance with regulatory and internal standards, and continuous process improvement across claims workflows.
This position will be located at our Rutherford, New Jersey home office. Consideration will be made for Remote based candidates.

Requirements

• Bachelor’s degree in Business, Insurance, Risk Management, or a related field required; Master’s degree preferred.
• 5+ years of experience in P&C claims operations within a TPA, insurance carrier, or equivalent environment.
• 3+ years of experience in quality, quality control, or audit functions, specifically supporting P&C claims.
• Strong understanding of P&C policy coverages, claims lifecycle, adjudication standards, and claims documentation best practices.
• Experience with industry quality standards and tools.
• Excellent written and verbal communication.
• Comfortable presenting to executive leadership and engaging at all organizational levels.
• Strong organization, prioritization, and project management skills.

Nice To Haves

• CPCU, AIC, ARM, CAMS or Six Sigma/Lean Certification.
• Prior experience in outsourced TPA quality frameworks vs. captive carrier environments is a plus.

Responsibilities

• Design and implement quality measurement tools, scorecards, checklists, and sampling methodologies.
• Define, maintain, and evolve quality assurance standards for P&C claims.
• Conduct regular quality audits, sampling claims across adjusters, teams, and lines of business.
• Ensure consistent application of standards, policies, and procedures across claims operations.
• Document and report findings. Provide actionable recommendations and monitor corrective action plan.
• Lead initiatives to improve claims accuracy, cycle times, compliance, and customer outcomes.
• Partner with operations leadership to identify training needs based on quality trends.
• Facilitate or deliver quality-focused training sessions for claims adjusters and supervisors.
• Drive projects to implement best practices, process enhancements, and automated quality controls.
• Serve as a subject matter expert and trusted advisor to Claims Operations Leadership.
• Work cross-functionally with training, compliance, operations, IT, and risk management teams.
• Coach and mentor quality analysts and support staff.
• Provide regular briefings to senior leadership on quality results, risks, and improvement plans.
• Establish and track quality KPIs, such as: Claims accuracy rate. Documentation completeness/consistency. Severity, subrogation, and reserve accuracy. Cycle time variances. Error rates by adjuster/team.
• Lead root cause analysis and track corrective action effectiveness.
• Ensure QA programs comply with state insurance regulations, industry standards, and contractual obligations.
• Maintain familiarity with NAIC guidelines, state-specific claims handling regulations (e.g., unfair claim settlement practices), and audit requirements.
• Support internal and external regulatory exams and audits as needed.

Benefits

• We offer a competitive compensation package commensurate with experience, including salary, bonus, paid time off, medical/dental/vision/life insurance and 401k (with matching!).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level