Senior Manager, Fraud & Claims Quality Control; QC

Description

The Senior Manager, Fraud & Claims Quality Control (QC) is responsible for the end-to-end leadership, strategy, and execution of the Fraud & Claims QC program. This role provides oversight of quality control frameworks, ensuring alignment with regulatory requirements, risk management standards, and business objectives.

This leader is accountable for driving a robust, forward-looking QC program that not only identifies risk but shapes operational improvements, enhances control effectiveness, and enables better business outcomes. The role requires a strong people leader with deep Fraud and Claims expertise, exceptional attention to detail, and the ability to lead through change in a complex, evolving environment.

• Own and continuously evolve the Fraud & Claims QC program strategy, including frameworks, methodologies, and governance
• Establish and maintain enterprise standards for QC execution, sampling, testing, and documentation
• Ensure QC programs provide accurate, comprehensive visibility into operational performance, regulatory adherence, and emerging risks
• Lead program enhancements, including sampling model changes, control redesign, and expanded QC coverage

• Lead, coach, and develop a team of QC Managers and analysts, building a high‑performing, accountable organization
• Set clear performance expectations aligned to business and risk objectives
• Drive a strong coaching culture, ensuring feedback is actionable, consistent, and tied to performance improvement
• Ensure effective capacity planning, prioritization, and execution discipline across the team

• Act as a senior leader responsible for maintaining a strong risk and control environment across Fraud & Claims QC
• Partner with Risk, Legal, Compliance, and business leaders to ensure controls are well‑designed and operating effectively
• Oversee issue identification, escalation, root cause analysis, and remediation of QC findings
• Ensure readiness and support for internal audits, regulatory exams, and governance forums

• Provide oversight of QC execution to ensure accuracy, consistency, and adherence to regulatory and procedural requirements
• Drive alignment across QC teams through calibration, standardization, and quality assurance routines
• Ensure QC outputs effectively identify process defects, compliance gaps, and operational risk trends
• Maintain a disciplined approach to documentation, evidence, and audit readiness

• Own and enhance QC reporting frameworks to deliver clear, concise, and actionable insights to senior leadership
• Translate QC results into strategic recommendations that drive business decisions
  
  Identify trends, systemic issues, and emerging risks through advanced data analysis and reporting
• Drive automation and reporting enhancements to improve efficiency and transparency

• Lead large‑scale transformation initiatives across the QC program
• Drive continuous improvement efforts to enhance quality, efficiency, and effectiveness
• Facilitate cross‑functional working sessions to solve complex operational and risk challenges
• Influence stakeholders and drive adoption of new processes, controls, and technologies

• Serve as a trusted advisor to Fraud & Claims leadership, providing insights on quality performance and risk exposure
• Build strong partnerships across Operations, Risk, Compliance, and Audit
• Influence decision‑making through data‑driven insights, sound judgment, and business acumen
• Represent the QC function in leadership forums, risk committees, and governance meetings

• Required Qualifications
  • 3+ years of leadership experience, including managing managers and/or leading large, complex teams
  • 3+ years of experience in Fraud, Claims, or Operations within a financial services environment
  • Demonstrated experience leading enterprise or program‑level initiatives
  • Strong decision‑making and problem‑solving…