Claims Operations Quality Assurance Specialist

Job Description:

Pacific Life is seeking talented Operations Quality Assurance Specialists to join our Consumer Markets Division in Omaha, NE or Charlotte,  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.

How You’ll Make an Impact:

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

How you’ll help move us forward:

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

The experience you bring: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

What makes you stand out:

Experience in life insurance claims, financial services, banking, healthcare claims,…