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Claims Quality Assurance Jobs (NOW HIRING)

Corvel

Claims Quality Assurance

Dallas, TX · On-site

$70K - $116K/yr

The Claims Quality Assurance serves as the technical claims expert for the Claims Operations by auditing compliance with established CorVel, industry and carrier claim handling standards. The primary ...

Corvel

Claims Quality Assurance

Dallas, TX · Remote

The Claims Quality Assurance serves as the technical claims expert for the Claims Operations by auditing compliance with established CorVel, industry and carrier claim handling standards. The primary ...

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Claims Quality Assurance information

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$15

$44

$64

How much do claims quality assurance jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for claims quality assurance in the United States is $44.87, according to ZipRecruiter salary data. Most workers in this role earn between $36.54 and $54.57 per hour, depending on experience, location, and employer.

What is claims quality assurance?

Claims Quality Assurance (QA) is a process within insurance and related industries that ensures claims are processed accurately, efficiently, and in compliance with company policies and regulatory requirements. Professionals in this role review and audit claims files, identify errors or inconsistencies, and recommend improvements to claim handling procedures. Their work helps reduce errors, prevent fraud, and maintain high standards of customer service.

What skills and qualifications are needed for claims quality assurance?

To thrive as a Claims Quality Assurance professional, you need a solid understanding of insurance claims processes, attention to detail, and experience with quality assurance methodologies, often supported by a relevant degree or industry certifications. Familiarity with claims management systems, auditing tools, and standards such as ISO 9001 is typically required. Strong analytical skills, effective communication, and problem-solving abilities help you excel in reviewing claims and providing constructive feedback. These skills ensure accuracy, compliance, and efficiency in claims handling, which are critical for minimizing errors and reducing financial risk.

What are common challenges in claims quality assurance and how can they be managed?

One common challenge in Claims Quality Assurance is ensuring consistency across a high volume of claims reviews while adhering to ever-evolving regulatory standards. QA professionals may also encounter discrepancies in documentation or incomplete data, which can complicate the review process. To manage these challenges, it's important to stay current with industry regulations, maintain clear communication with claims adjusters, and utilize standardized checklists or audit tools. Regular training and collaboration with other departments help ensure best practices are followed and errors are minimized.

What is the difference between Claims Quality Assurance vs Claims Examiner?

AspectClaims Quality AssuranceClaims Examiner
CertificationsCertifications like CPC or similar are commonCertifications like CPC or similar are common
Work EnvironmentTypically office-based, focusing on review and auditsOffice or remote, handling claim processing and review
Employer & IndustryInsurance companies, third-party administratorsInsurance companies, healthcare providers

Claims Quality Assurance professionals focus on reviewing and auditing claims to ensure accuracy and compliance, while Claims Examiners process and evaluate individual claims for approval or denial. Both roles require similar certifications and work in insurance environments, but their core responsibilities differ: QA specialists focus on quality control, whereas examiners handle claim decisions.

More about Claims Quality Assurance jobs

What cities are hiring for Claims Quality Assurance jobs?

Cities with the most Claims Quality Assurance job openings:

What states have the most Claims Quality Assurance jobs?

States with the most job openings for Claims Quality Assurance jobs include:

What job categories do people searching Claims Quality Assurance jobs look for?

The top searched job categories for Claims Quality Assurance jobs are:

Claims Quality Assurance jobs near you
Infographic showing various Claims Quality Assurance job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, 4% Contract, and 1% Nights. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $93,338 per year, or $44.9 per hour.

Claims Quality Assurance

CorVel Enterprise Claims, Inc.

Dallas, TX • Remote

Full-time

Posted 18 days ago

Job description

The Claims Quality Assurance serves as the technical claims expert for the Claims Operations by auditing compliance with established CorVel, industry and carrier claim handling standards. The primary responsibility is evaluating claim handling quality, accuracy, and timeliness in categories including but not limited to: coverage analysis, investigation, valuation, reserving, compliance and accurate disposition of claims. This role has the ability to interpret results and trends in order to deliver operational reporting and participate in the development and presentation of training.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

  • Model ethical behavior and executes job responsibilities in accordance with CorVel’s core values, ethics, and information protection policies
  • Serve as technical QA lead to assigned offices or departments
  • Lead QA projects and serve as primary coordinator for senior leadership of assigned offices
  • Support the Claims Quality Assurance Program and the EC Operations Team in developing and implementing quality improvement strategies
  • Lead the creation, presentation, execution, and calibration of Quality Assurance Training sessions, including integration and delivery of claims training programs in the context of Quality Assurance calibration exercises (e.g. policy, systems, workflows, statutes), taking steps toward target results and the acquisition of target skills-sets, creation, maintenance, and adjustment of quality assurance training materials as needed for use in quality assurance training sessions
  • Report on pending payments, reserves, Adjuster POA/Supervisor review compliance, leakage, and various reports to assess operational performance and compliance to CorVel standards
  • Monitor claim financials; perform routine follow ups for audits identifying reserve deficiencies or pending aspects of claim liability or compensability; Ensure carrier reporting deficiencies have also been corrected
  • Maintain and update in real time quality, quantity, and turn-time standards
  • Conduct testing on software, websites, and other technical products to identify and resolve defects, and other potential claims processing issues
  • Review claim process specifications to understand the scope, requirements, and function of each product
  • Identify appropriate parameters, functions, and data to test and validate; parameters may include general function, validity of results, accuracy, reliability, and compliance with industry standards
  • Conduct testing to ensure products perform according to user requirements and within established guidelines; if a product does not perform within specifications, report defects to EC Operations and the BOT teams identifying and recommending solutions, improvements, and updates
  • Submit operational QA reporting to EC Ops at durations outlined; operational reporting to include written corrective action plans for areas of deficiency identified during the QA review process
  • Participate in strategic operational calls with EC Operations and claims leadership when the QA process has identified a significant operational deficiency
  • Work with EC Operations to insert QA corrective action plans required by a carrier or client

KNOWLEDGE & SKILLS:

  • Excellent written and verbal communication; demonstrated ability to provide superior service to internal and external stakeholders
  • Effective quantitative, analytical and interpretive skills
  • Excellent leadership and mentorship skills, with a demonstrated ability to motivate staff and obtain results through teamwork and education
  • Ability to identify priorities, execute and handle multiple responsibilities in a dynamic, fast paced environment
  • Strong proficiency with Microsoft Office applications
  • Strong interpersonal, time management, project management, and organizational skills
  • Ability to maintain a high level of professionalism
  • Knowledge of the entire claims administration processes including ancillary services
  • Ability to remain poised in stressful situations and communicate with diplomacy, using written and verbal communication
  • Ability to work independently or in a team environment while functioning as an educator rather than an auditor

EDUCATION & EXPERIENCE:

  • Bachelor’s Degree with course concentration in Business Administration, or related field; or 5+ years of equivalent combination of education and experience in a complex healthcare, insurance, or third-party claim organization with significant claim management expertise
  • Must have significant industry experience and a thorough understanding of CorVel’s proprietary systems and solutions
  • Certified Trainer and/or Quality Assurance experience a plus

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $70,276 – $116,942

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CORVEL

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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