Quality Assurance & Compliance Specialist

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Full-time Regular Technical

6 days ago Requisition

Salary Range: $85,000.00 To $ Annually

K2 Claims Services, LLC (“K2 Claims”) is seeking an experienced Quality Assurance & Compliance Specialist to expand and strengthen our established quality assurance program across the homeowners/personal property and liability claim teams. As a third-party administrator (TPA), K2 Claims services specialty programs across property, homeowners, general liability, auto, builder’s risk, professional liability, and workers’ compensation on behalf of a diverse group of carrier and program partners.

This role builds on K2’s existing quality assurance program. The successful candidate will administer audit scorecards, conduct routine and targeted file reviews, report trends across teams and programs, and work with managers to strengthen claim handling, while serving as K2’s internal point of preparation for carrier, client, and regulatory audits.

This is a highly visible, cross-functional position reporting to senior leadership in both the Personal Lines and Commercial/Liability organizations. It is an opportunity to take ownership of an existing program, shape where it goes next, and help a well-established, growing company continue building a world-class TPA.

• Claim File Audits: Conduct scheduled and targeted audits of open and closed claim files across homeowners/personal property and general liability/casualty lines, measuring adherence to K2 Claims Best Practices, client-specific handling instructions, and applicable state regulations.
• Full Lifecycle Review: Evaluate the complete claim lifecycle including FNOL handling and contact timeliness, investigation quality, coverage analysis and documentation, reserve adequacy and supporting rationale, damage evaluation and estimating, negotiation and settlement, diary management, file note quality, payment accuracy, and proper closure.
• Coverage Correspondence: Verify that reservation of rights letters, coverage declinations, and other coverage correspondence are accurate, timely, professionally drafted, and cite the correct policy forms, endorsements, and exclusions.
• Litigation Management Review: Assess counsel referral timeliness, litigation plans and budgets, defense counsel oversight, documented settlement authority, mediation preparation, and large loss reporting to carriers and clients.
• Recovery & Referral Review: Confirm that subrogation, salvage, contribution, risk transfer, and Special Investigation Unit (SIU) opportunities are identified, referred, documented, and pursued.
• Objective Scoring: Score files against a standardized audit template, documenting exceptions with evidence-based findings tied to specific file entries so results are consistent, reproducible, and actionable across teams.

• Regulatory Adherence: Monitor compliance with state Fair Claims Settlement Practices and Unfair Claims Practices requirements, statutory acknowledgment, investigation, and decision deadlines, and state-specific notice, delay, and letter requirements.
• Statutory Reporting: Support compliance with Medicare Secondary Payer / Section 111 reporting obligations, lien resolution protocols, anti-fraud referral requirements, and privacy and data handling obligations governing claim files.
• Client & Carrier Standards: Maintain audit-ready documentation supporting K2’s obligations under client service agreements, program guidelines, and carrier claim handling standards, including contractually required reporting, service level commitments, and file documentation expectations.
• External Audit Coordination: Serve as the internal coordinator for carrier, client, regulatory, and market conduct audits — assembling file samples, preparing narrative responses, and tracking remediation of findings through closure.

• Audit Reporting: Produce audit scorecards, exception summaries, trend reports,…