Fraud Claims Operations Representative Jobs (NOW HIRING)

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.

Key Responsibilities

Program Leadership & Strategic Oversight

• 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

People Leadership & Organizational Effectiveness

• 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

Risk, Control & Compliance Leadership

• 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

Quality Oversight & Execution Excellence

• 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

Data, Reporting & Executive Insights

• 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

Change Leadership & Continuous Improvement

• 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

Business Partnership & Influence

• 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

Qualifications, Education, Certifications and/or Other Professional Credentials

• 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 ability, with comfort operating in ambiguity
  • Exceptional attention to detail and risk awareness
  • Proven ability to coach, develop, and lead high-performing teams
  • Strong organizational and execution skills, with ability to manage competing priorities
  • Advanced analytical and critical thinking skills
  • Excellent communication and executive presence, with ability to influence senior stakeholders
• Preferred Qualifications
  • Experience in Quality Assurance (QA) or Quality Control (QC) program leadership
  • Background in Risk Management, Compliance, or Internal Audit
  • Experience supporting regulatory exams or large-scale audits
  • Strong understanding of Fraud & Claims processes across multiple products (Debit, Credit Card, ACH, ID Theft, etc.)
  • Experience leading process transformation, automation, or change management initiatives

Hours & Work Schedule

• Hours per Week: 40
• Work Schedule:  Hybrid Schedule (4 days in Office) Monday - Friday, 8:00am-5:00pm

Some job boards have started using jobseeker-reported data to estimate salary ranges for roles. If you apply and qualify for this role, a recruiter will discuss accurate pay guidance.

Equal Employment Opportunity

Citizens, its parent, subsidiaries, and related companies (Citizens) provide equal employment and advancement opportunities to all colleagues and applicants for employment without regard to age, ancestry, color, citizenship, physical or mental disability, perceived disability or history or record of a disability, ethnicity, gender, gender identity or expression, genetic information, genetic characteristic, marital or domestic partner status, victim of domestic violence, family status/parenthood, medical condition, military or veteran status, national origin, pregnancy/childbirth/lactation, colleague's or a dependent's reproductive health decision making, race, religion, sex, sexual orientation, or any other category protected by federal, state and/or local laws. At Citizens, we are committed to fostering an inclusive culture that enables all colleagues to bring their best selves to work every day and everyone is expected to be treated with respect and professionalism. Employment decisions are based solely on merit, qualifications, performance and capability.