Claims Audit Specialist Disability Management

Lead claims file audits and quality reviews at Pacific Blue Cross, using strong judgement and Disability Management knowledge in a hybrid arrangement.As an experienced Quality Assurance Advisor, you will independently evaluate claims management practices and compliance. Your findings will become practical recommendations for operational managers. The position also contributes insights to learning, performance management, continuous improvement, and training requirements. You will manage your review portfolio independently while communicating feedback compassionately and clearly.Key Responsibilities:
Review claims files and assess management practices objectivelySupport compliance with insurance requirements through quality oversightSummarize findings, trends, risks, and improvement opportunitiesInform learning modules and continuous training requirementsDrive consistency across claims management processesRequirements:
Certificate in Disability Management or relevant bachelor’s degreeFive to eight years in claims adjudication or case managementComplex STD and LTD planning, intervention, and return-to-work experienceExperience conducting claims audits or quality assurance reviewsAbility to deliver compassionate, respectful, and firm feedbackUse detailed claims review, compliance evaluation, and recommendation skills to influence stronger practices without direct reports.
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